TUBOPLASTY fallopian

Tuboplasty of the Fallopian Tubes

Objective

In case of :

•       Tubal obstruction

•       The reopening of the Fallopian tubes.

Position

Supine.

Anesthesia

General.

Procedure

         1.      Pfannenstiel incision.

         2.      Peritoneal cavity is entered.

         3.      Self-retaining retractor is placed.

         4.      Inject methylene blue through a cervical cannula.

         5.      Tuboplasty is performed according to the site obstruction.

         6.      Cornual resection with reimplantation.

         7.      Tubal resection with anastomosis.

         8.      Or fimbrioplasty.

         9.      Operating microscope is often used.

         10.    The abdomen is closed in layers.

Instruments

•       Dilatation and curettage set.

•       General set.

•       Microinstruments (e.g., smooth and toothed forceps, tying forceps, castroviejo needle holder, scissors) (Figs 8.40 and 78).

•       Beaver knife handle (Fig. 10.35).

•       Mosquito hemostats (6 curved, 2 straight).

•       Frazier suction tips (assorted) (Fig. 12.9).

•       Dye (e.g., methylene blue).

•       Perineal pad.

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Shirodkar's Operation

SHIRODKAR PROCEDURE

Objective

In case of:

•   Spontaneous abortion.

•   An encircling tape ligature at the level of the internal os to strengthen the cervical canal.

Position

Lithotomy.

Anesthesia

Epidural or general.

Procedure

1.  Transverse incision in the vaginal mucosa at junction with the anterior aspect of the cervix.

2.  A similar incision posteriorly.

3.  Tape ligature is passed on a ligature carrier to encircle the cervix.

4.  Tape is tightened and sutured.

5.  The mucosal wounds are closed.

Instruments

•   Dilatation and curettage (D and C) set.

•   Short Heaney retractors (Fig. 10.19).

•   Ligature carrier (Fig. 21.1).

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Salpingo oopherectomy

Salpingo-Oophorectomy

Objective

In case of:

•       disease.

•       removal of a Fallopian tube and corresponding ovary.

Position

Supine.

Anesthesia

General.

Procedure

         1.      A low midline, paramedian, or Pfannenstiel incision is employed.

         2.      Peritoneal cavity is entered.

         3.      A self-retaining retractor is place.

         4.      The patient is placed in Trendelenburg position.

         5.      Intestines are protected by laparotomy pads if adhesions are present.

         6.      The affected tube and ovary are isolated from surrounding organs.

         7.      Infundibulopelvic ligament is ligated and divided.

         8.      The broad ligament attachment of the tube and ovary.

         9.      The tube and ovary are excised.

         10.    Site reperitonealized.

         11.    Wound is closed in layers.

Instruments

•       General set.

•       Self-retaining retractor (e.g. Balfour or O’Connor O’Sullivan) (Fig. 8.100).

•       Somer’s clamp (Fig. 10.34).

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Total Abdominal Hysterectom

Total Abdominal Hysterectomy

Objective

In case of :

•       Tumor or bleeding

•       Removal of the entire uterus through an abdominal incision.

Position

Supine.

Anesthesia

General.

Procedure

         1.      A Pfannenstiel, vertical, midline, or paramedian incision is employed.

         2.      The peritoneal cavity is entered, and a self-retaining retractor is placed.

         3.      The patient is placed in Trendelenburg position.

         4.      Intestines are protected with warm moist packs.

         5.      Sutured and tagged with hemostat after indentifying the ureters.

         6.      Broad ligaments are incised.

         7.      Bladder is reflected from the anterior aspect of the cervix.

         8.      Infundibulopelvic ligaments are ligated and divided.

         9.      Vagina is incised circumferentially and the uterine specimen removed.

         10.    Hemostasis is secured.

         11.    Vaginal cut is closed; a drain may be used.

         12.    The pelvic peritoneum is approximated, and the wound is closed.

Instrument

•       General set

•       Laparotomy set

•       Balfour self-retaining retractor with Doyen blades (Fig. 8.100)

•       Suprapubic retractor Doyen (Fig. 10.15)

•       Long heavy scissors (10 in) (Fig. 10.6)

•       Vulsellum (Teale) (Figs 10.3 and 10.4)

•       Utrine dressing forceps (Fig. 10.24)

•       Artery forcep curved (8 in) Mayo    10

•       Osehner or Kocher Artery forcep

         curved (8 in) Mayo       6 (Fig. 8.32)

•       Osehner or Kocher 

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ANTERIOR & POSTERIOR COLPORHAPHY

ANTERIOR AND/OR POSTERIOR COLPORRHAPHY

Objective

In case of:

•   bulge in vagina.

•   repair and reinforcement of musculofascial support of the bladder and urethra (anteriorly) and distal rectum (posteriorly).

•   to prevent protrusion of the structures through the vaginal wall.

Position

Lithotomy.

Anesthesia

Epidural or general.

Procedure

   1.  Cervix (if present) is grasped with a tenaculum. For anterior colporrhaphy the anterior vaginal mucosa is incised in the midline.

   2.  The incision is deepened into the musculofascial wall.

   3.  Plication sutures are placed in the musculfascial tissues.

   4.  Excess of the priviously stretched vaginal mucosa is excised the mucosal incision is approximated.

   5.  Posterior colporrhaphy an incision is made at the mucocutaneous junction.

   6.  Perirectal fascia is separated and plicated.

   7.  The levator muscles are approximated at the midline to an appropriate degree of tension.

   8.  Excess vaginal mucosa is excised.

   9.  The mucosal incision is closed.

10.  A vaginal pack may be placed.

Instruments

Vaginal hysterectomy set

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VAGINAL HYSTERECTOMY

VAGINAL HYSTERECTOMY

Objective

•   In cases of tumor or bleeding from uterus.

•   removal of the uterus through a vaginal approach.

Position

Lithotomy.

Anesthesia

Epidural or general.

Procedure

   1.  A weighted vaginal speculum is placed in the vaginal canal.

   2.  Cervix is grasped with a tenaculum.

   3.  Dilatation and curettage may be performed.

   4.  An incision is made anterior to the cervix in the vaginal wall.

   5.  The bladder is reflected from the cervix using sharp, then blunt dissection.

   6.  Exposing the peritoneum of the anterior cul-de-sae, which is then incised, posteriorly.

   7.  Uterosacral ligaments are ligated and divided.

   8.  Uterus is placed on traction.

   9.  Uterine arteries are ligated and divided, and the uterus is delivered.

10.  The incisions into the cul-de-sac and vaginal apex are repaired.

11.  Uterosacral and round ligament stumps may be sutured to the angles of the vaginal vault closure.

12.  The vagina may be packed.

Instruments

•  General set-one                               10 (Fig. 8.51)

•  Artery forceps Spencer Wells (8 in)

•  Deep retractors (Deavor)                 2

•  Artery forceps (8 in) (Kocher)          6 (Fig. 8.55)

•  Vulsellum (Teale)                             2 (Fig. 10.30)

•  Scissors heavy curved (8 in) Mayo   1 (Fig. 8.32)

•  Auvards vaginal speculum (Fig. 10.33).

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