Abdominal hysterectomy.pptx

1. Abdominal
hysterectomy

2. Definition and types
 Def - the operation of removal of uterus -hysterectomy.
 Uterus is removed abdominally –abdominal hysterectomy.
 Types-5
 1)Total hysterectomy- removal of entire uterus.
 2) Subtotal- removal of the body or corpus leaving behind the cervix.
 3) Pan-hysterectomy- removal of entire uterus along with removal of tubes
and both ovaries . Also known as bilateral salpingo-oophorectomy.
 4) Extended hysterectomy - pan-hysterectomy with removal of cuff of vagina
 5)Radical hysterectomy - removal of entire uterus, along with removal of
tubes ovaries upper 1/3rd of vagina ,adjacent parametrium, and draining
lymph nodes of the cervix.

3. Indications
 Bening lesion- DUB malignancy -CA cervix
 Fibroid uterus -CA ovary
 Tubo -ovarian mass -CA endometrium
 Endometriosis - uterine sarcoma
 Adenomyosis Traumatic –uterine perforation
 Cervical intraepithelial neoplasm - cervical tear
 Endometrial hyperplasia -ruptured uterus
 Benign ovarian tumor obstetrical- Atonic PPH ,septic abortion.

4. Pre-operative procedures
 Pre-operative evaluation –detailed history- general ,medical, surgical
 Physical and systemic examination
 Routine Investigations- blood –CBC ,Blood group ,cross matching ,BSL ,LFT
,RFT .
 Urine test –routine microscopic
 Chest X-ray and ECG
 2Decho and coagulation profile if necessary according to systemic disease
investigation done.
 Serology-HIV ,HBsAG
 Anaesthesia review or fitness.

5. Pre-operative procedures
 Pre-operative councelling
 Informed written consent
 Diet –light diet is given in the previous night. NBM at least 8hr prior to
surgery.
 Bowel preparation – Enema is given in the previous night.
 Night sedation –for good sleep at previous night.
 Part preparation-shaving the operative area.
 Pre-operative medication- antibiotics-to minimise infection and maintain
adequate tissue level of antibiotics for duration of operation. Mostly broad
spectrum antibiotics used.

6. Pre-operative procedures
 IV Fluids-RL
 The patient is brought into the operating room and placed in the supine
position on the operating table.
 The parts (abdomen in abdominal hysterectomy , vagina and perineum in
case of vaginal hysterectomy) are prepared with antiseptic solutions and a
Foleys catheter is inserted.
 position - supine on the operative table
 Anaesthesia-spinal anaesthesia
 Painting done with povidion iodide solution and sterile drapes are applied.
 Incision - low transverse incision; most gynaecologists prefer a Pfannenstiel
incision , a midline incision generally is done if malignant disease is present or
exposure to the upper abdomen may be required.

7. Operative procedure
 Abdomen opened layer wise i.e. skin ,superficial fascia ,deep fascia , rectus
sheath ,rectus muscle, peritoneum . Once the abdomen is opened, the pelvic
pathology is carefully evaluated and the abdomen explored.
 After the abdomen has been explored, a slight Trendelenburg position should
be requested, a self-retaining retractor placed, and the bowel packed
superiorly to afford good exposure of the pelvis.
 The round ligaments and utero-ovarian ligaments are grasped on each side
with a Kocher clamp, elevating the uterus out of the pelvis. Clamping the
round ligament.

8. b/l round ligament clamped ,cut ,transfixed sutured
with vicryl no 0


9. If ovaries are to be removed ,paired clamp are placed in infundibulo -pelvic
ligament. A window is created in brad ligament medial to IP ligament.tissues in
between cut and replaced by transfixed sutures.

10. When the ovary is to be conserved, a peritoneal window is made above
the ureter and the tube and utero-ovarian ligament are clamped ,cut and
replaced with transfixed suture.(at cornue of uterus include tubes
mesoslpings ovarian ligament)

11. Loose peritoneum of the uterovesical fold is cut and extended from one
devidedd round ligament to other. The bladder push downward and gauze
added. To minimise injury.

12. Paired clamp placed on uterine artery at the level of internal os.
ligament.tissues in between cut and replaced by transfixed sutures.

13. Uterus pulled forward to make uterosacral ligament prominent. Clamp placed
over uterosacral ligaments close to cervix.ligamets cut .the peritoneum in
between ligament dissected down. And clapms replaced by sutures.clamps are
placed close to cervix on paracervical tissue containg cervical arter ,cut and
transfixed.

14. Vault of vagina is opened by stab incision .Edges of vaginal vault
are grasped with allies forceps and transfixed .

15. complications
 1) Intraoperative-Haemorrhage
 Visceral organ injury
 Anaesthesia hazards-pulmonary oedema
 2) Post operative-immediate- hypovolemia-shock
 Urinary-retention cystitis, anuria
 Late- stress ,pyrexia,haemorrhage,DVT

16. Post operative care
 First 24hr-
 Monitoring- P, BP, input-output ,bleeding,AG ,IV Fluids
 Early mobilisation-leg movement to avoid DVT
 BT if required
 Pain control-NSAID
 Antibiotics
 Bladder care
 Bowel care
 Diet-NBM max-6-8hr .-oral liquid- soft diet-regular diet

17. Thank you