Total Abdominal Hysterectomy
The patient was prepped and draped in the usual sterile manner for an abdominal procedure. An incision was made into the abdomen down through the subcutaneous tissue, muscular fascia and peritoneum. Once inside the abdominal cavity, a self-retaining retractor was placed to expose the pelvic cavity with 3 lap sponges. The uterus was then identified and grasped on the fundus with a double-toothed tenaculum with upward traction. The round ligaments on either side were identified and individually dissected and ligated with #0 Vicryl suture and divided. This allowed us to then create a bladder flap by both blunt and sharp dissection. The fallopian tube and ovarian ligament were isolated through the broad ligament from the uterine body and ligated with #0 Vicryl suture and divided as well. We then skeletonized the uterine vessels on either side and carefully dissected the bladder flap anteriorly. Posteriorly, the peritoneum was dissected down toward the uterosacral ligaments. Heaney clamps were then placed at each isthmic portion of the cervical body junction where the uterine arteries adjoined the uterus. These were clamped, ligated and divided using #0 Vicryl suture. The remainder of the uterus was then removed by the clamp-cut-ligation technique using #0 Vicryl on all major pedicles. With removal of the uterus, the vaginal cuff was closed in the usual manner as dictated in the operative findings above. Hemostasis was then inspected and secured throughout the entire area. We closed the peritoneum over the vaginal cuff using #2-0 Vicryl suture in a running continuous manner. The ovaries were left in situ and suspended to the sidewalls. The lap sponges were then removed and the self-retaining retractor was removed. The patient tolerated the operation nicely. There were no complications associated with this surgical procedure to this point. The sponge count was correct times 2 at this time. The Foley catheter was inspected and clear urine was noted. Having removed all instruments and packs, we then began closure of the abdomen. The peritoneum was closed with #2-0 Vicryl in a running continuous manner. The fascia was closed with #0 Vicryl in a running continuous manner and the subcutaneous tissue was also closed with #2-0 Vicryl in a running continuous manner. Hemostasis was secured throughout the entire layers. The incision was then closed as noted in the above operative findings. The patient tolerated the operation nicely and was then taken to the Recovery Room in good condition.