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Vaginal Hysterectomy
Kaidy Waterman & Emily Beacham
Anatomy and Physiology
Removal of uterus Possible removal of fallopian tubes and ovaries Ligature of uterosacral ligaments Ligature of cardinal ligaments Ligature of uterine arteries Possible ligature of round ligament, ovarian
ligament and fallopian tubes
Reasons for Procedure Sterilization Endometriosis Fibroids Cancer Adhesions Uterine prolapse
About 1/3 of all hysterectomies are done vaginally
Doctors prefer vaginal because it is less invasive
Laparoscopically assisted vaginal hysterectomies are becoming much more common
General DetailsAnesthesia and
Positioning Anesthesia is general Patient is in lithotomy
position Candy cane stirrups
Skin Prep and Draping
Vaginal prep Lithotomy drape
Supplies, Equipment and Instruments
Auvard weighted speculum
Heaney/Deaver retracters
Tenaculum/Lahey vulsellum
#15 blade #7 knife handle 4X4 sponges Peri-Pad
Heaney clamps Mayo scissors Long mayo Kelly clamps Schnidt Pean Jacob’s vulsellum Foley catheter Vag packing
Special Considerations Careful with catheterization after the procedure Care must be taken not to damage the fallopian
tubes or ovaries if they are going to remain in the body
The Procedure
1. TIME OUT2. Auvard weighted speculum is placed in the
posterior vaginal wall3. Heaney or Deavers retract the lateral vaginal
walls4. Tenaculum/Lahey placed at the edge of cervix to
permit traction and movement.o D&C may be performed here
5. #15 blade on #7 handle, incise vaginal wall anteriorly around cervix
6. Blunt dissection, index and middle finger with 4X4, free bladder from anterior surface of the cervix
7. Deaver is placed anteriorly to elevate the bladdero Protects bladdero Visualization of peritoneum and anterior cul-de-sac
8. Use #15 knife blade, opening is made in the cul-de-sac
9. Peritoneum of posterior cul-de-sac is identified and incised with #15
10. Uterosacral ligaments are doubly clamped with Heaney clamps, cut with Mayo and ligated.o Ligatures are not cut-left long and tagged with kelly
11. Manipulate uterus posteriorly, cardinal ligaments on each side are doubly clamped and cut with Mayos and ligated
12. Same is done with uterine arteries except the clamps are Kelly, Schnidt, or Pean
13. Fundus is put into the vaginal canal with previously placed tenaculum/Jacob’s vulsellum
14. If ovaries are preserved:o Round ligamento Ovarian ligament o Fallopian
are doubly clamped with Heaney clamps, cut with mayo
15. Uterus is removed16. Pedicles of the ligaments are ligated
17. Peritoneum between rectum and vagina is approximated with a continuous absorbable suture
18. Cul-de-sac is closed by placing sutures from vaginal wall through infundibulopelvic and round ligaments and back out through the vaginal wall, tied down on the vaginal portion of the vault
19. Round, uterosacral, and cardinal ligaments are individually approximated and reattached to the angle of the vagina
20. Foley catheter is placed, vagina is packed, perineal pad is placed.
Postoperative Care
Complications Bowel obstruction or
damage Bladder injury Wound infection of
dehiscence Ureteral injuries Hemorrhage
Care and Prognosis Transport to PACU Return to normal
activities
Pearl of WisdomSome surgeons complete actions on one side of the uterus then move to the other side; some alternate sides as they
move caudally. The STSR must adjust to the pattern and be sure to have an adequate supply of homeostasis.
http://www.lumitex.com/gynecology.html