Total Abdominal Hysterectomy

 

Patient Name: @name@

MRN: @mrn@

Procedure Date: @td@

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Attending Surgeon:

Assistant:

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PREOPERATIVE DIAGNOSES: @age@ year old @gp@ with *** who desires definitive management with a total abdominal hysterectomy

POSTOPERATIVE DIAGNOSES: Same

PROCEDURES: Total abdominal hysterectomy, bilateral salpingo-oophorectomy

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INTRAVENOUS FLUIDS: ***

ESTIMATED BLOOD LOSS: ***

URINE OUTPUT: ***

SPECIMENS: 1. Uterus, cervix, bilateral tubes and ovaries

COMPLICATIONS: None.

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INDICATIONS: This is a @age@ year-old @gp@ who presents with ***

OPERATIVE FINDINGS: ***

 

PROCEDURE IN DETAIL: 

The patient was re-consented as to the risks/benefits/indications for her procedure and agreed to proceed. ***Pre-operative heparin, gabapentin and tylenol was administered and a skin prep was performed in pre-op holding.

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The patient was brought to the OR, SCD devices were placed on both calves, IV antibiotics were administered and she underwent general anesthesia without difficulty. She was placed in dorsal lithotomy position with Allen stirrups with the arms on the arm boards. She was prepped and draped in the usual sterile fashion.  A safety timeout was performed for patient safety. The foley catheter was inserted into the bladder using sterile technique. A ***vertical abdominal incision was made with dissection through the subcutaneous tissue down to the abdominal rectus fascia in order to allow adequate exposure to the pelvis and again taken through each of the  individual layers of the abdominal wall carefully. A ***Bookwalter retractor was placed and the bowels were packed out of the pelvis gently.

 

The round ligament on the left was transected and the retroperitoneum opened. The pelvic peritoneum was released parallel to the IP and the retroperitoneum opened including the pararectal space. The left ureter was easily identified on the medial leaf of the broad ligament, a window was created above  the ureter and below the IP. The IP's were clamped, cut and suture ligated. There was good hemostasis. The posterior leaf of the broad ligament was dropped down to the lower uterine segment. The anterior leaf was dissected to start the bladder flap. The same process was repeated on the right.

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The bladder flap was dropped further from the lower uterine segment down to the anterior cervix and gradually the cervical vaginal junction and a good plane was obtained. The right uterine vessels were further skeletonized, then clamped, cut, and suture ligated for good hemostasis to the level of the utero-sacral ligament. A similar procedure was performed on the left. The cervix was clamped with sharply curved Zeppelins and Jorgenson scissors were used to create colpotomy. Next, 0 Vicryl Heaney stitches were placed at bilateral angles of the vaginal cuff and figure-of-eights were placed in between for good hemostasis. The pelvis was examined and irrigated thoroughly and was hemostatic. Ureters were again examined and found to be peristalsing and in good position. All sponges and retractors were removed from the abdomen with correct sponge and instrument counts. The fascia ***and peritoneum were closed en bloc using *** looped maxon suture from either end of the incision. The subcutaneous tissue was irrigated and closed with ***2-0 vicryl. The skin was closed using ***4-0 biosyn in a subcuticular fashion. Anesthesia was reversed and the patient was taken to the PACU in stable condition.