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Abdominal Hysterectomy

Definition
  • Surgical disruption of the whole uterus through an abdominal incision.
  • A hysterectomy is indicated for a multiformity of provisions, including endometriosis, adnexal distemper, postmenopausal bleeding, dysfunctional uterine bleeding, and merciful fibromas or pernicious tumors.
  • For women in their childbearing years, this surgery, as succeeding a while a vaginal hysterectomy, can be a devastating misfortune psychologically, since they may feel they entertain obsolete their principal sexual idiosyncrasy and accordingly can no desireer operation as women.
Positioning
  • Supine, succeeding a while encounter bland on armboards.
Incision Sites
  • Lower rectangular (Pfannenstiel), upright, midline, or paramedian.
Packs/ Drapes
  • Laparatomy saffectionate and/ or rectangular Lap fencing.
  • Four contracted towels
Instrumentation
  • Major Laparotomy tray or abdominal hysterectomy tray
  • Self-retraining retractor
  • Internal stapling instruments
Supplies/ Equipment
  • Basin set
  • Blades
  • Needle enumerateer
  • Suction
  • Foley catheter succeeding a while drainage bag
  • Solutions
  • Suture
  • Internal stapling
Procedure Overview
  1. After incising the peel, the incision is intenseened through the subcutaneous web succeeding a while the intense knife or cautery pencil.
  2. The fascia is nicked succeeding a while the intense knife and incised using a serpentine Mayo dissecting scissors.
  3. Grasping one policy of the fascial aspect succeeding a while two or more Kocher clamps, numb resolution separates the fascia from the underlying muscle.
  4. The muscle is disjoined manually. The peritoneum is then knicked succeeding a while the intense knife, and the incision is lengthened succeeding a while Metzenbaum scissors.
  5. A self-retraining retractor is placed in the pain, succeeding a while fresh lap defends to guard the pain policys; the surgeon get “saffectionate the bowel” far from the uterus succeeding a while adductional fresh affectionate Lap defends, and the encourageted board is placed in contempt Trendelenberg lie.
  6. The uterus is incomplex by severing it from the uterine ligaments ans adnexa.
  7. The plump ligaments of the uterus are ligated, disjoined, continuityd, and tagged succeeding a while a hemostat.
  8. To sever the ligaments, a serpentine Mayo scissors or scalpel is used. An interior stapling plan can be used to careless the uterus from the adnexa.
  9. The surgeon mobilizes the uterus to the flatten of the bladder.
  10. Using a Metzenbaum scissors and desire web forceps, the surgeon separates the two structures by dissecting the peritoneal protection far from the bladder. This is determined the bladder flap, and get be reattached (reperitonealized) later.
  11. Once the bladder has been disjoined from the uterus, mobilization is continued.
  12. At the flatten of the cervix, desire Allis or Kocher clamps are placed aplump the policy of the cervix, and it is disjoined from the vagina using a desire scissors or a desire knife.
  13. If the ovaries are to be preserved, the ovarian ligaments is ligated and disjoined adjacent to the uterus.
  14. The uterosacral ligaments are ligated and disjoined, adesire succeeding a while the consummate ligaments.
  15. To delay the pain, the surgeon begins by suturing the vaginal vault using an absorbable continuity.
  16. The pain is irrigated succeeding a while affectionate important, and hemostasis is achieved.
  17. To delay the peritoneum, the surgeon grasps the policys succeeding a while separate Kelly hemostats and the peritoneum is delayd succeeding a while a exoteric continuity.
Peribinding Nursing Considerations
  1. Foley catheterization is usually produced succeeding the interior vaginal prep is completed but anteriorly the abdominal prep is begun.
  2. A sterilization encourage may be required in adduction to the binding encourage.
  3. Instruments that entertain end in continuity succeeding a while the cervix and or vagina must be treated as vitiated and discarded into a basin that can be passed off the grant.
  4. Once the abdomen is opened, 4 x 4 Raytec defends should be replaced by Lap defends.
  5. If a careless defend has been placed in the vagina preceding to withdrawal, it is interposed in the defend enumerate and must be removed from the vagina anteriorly the enumerate is improve and the resigned leaves the admission.
  6. Internal staples are usually contraindicated in rigid cases of pelvic exasperating distemper or endometriosis

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