Tuesday, November 14, 2017

Global surgery outreach missions : abdominal hysterectomy tips

In many mission hospitals, the surgeon is often requested by gynecologist friends to help with abdominal hysterectomy.
The patient in this case was a middle aged multi, with chronic DUB and a posterior adnexal fibroid close to the cervix.

I share some useful tips during mission hospital demo sessions:

1. In this case the preferred incision was vertical
2. I always like to mobilise the uterus by dividing and ligating  the round ligaments first
3. The ureters are identified in the medial leaves of the broad ligaments and displaced laterally with wet gauze
4. The uterus is devascularized from the broad ligaments to isthmus
5. Uterine vessels are divided by using a Heany clamp at right angles to the longitudinal axis of the uterine body; stay close to the uterus.the ureters are behind the vessels at about a cm distance - they are displaced laterally by a wet gauze.
6. Divide and suture the cardinal ligaments,with clamps almost parallel to the body of uterus ,after dividing the uterine arteries
7. The bladder is always dissected away from the uterus in the initial steps.
8. To prevent vault prolapse, the cardinal ligaments are fixed to utero sacral ligaments
9. Hemostatic transfixion sutures like the heany stitch or tailor stitch are reliable and prevent blood loss.

Following these tips make your procedure relatively easier and blood loss will also be negligible.

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