Total abdominal hysterectomy and bilateral
salpingo-oophorectomy (TAH-BSO)
Removal of the uterus, cervix and both fallopian
tubes and ovaries.
• Hysterectomy may be total, as removing the body and
cervix of the uterus or partial,also called supra-cervical.
• Salpingo refers specifically to the fallopian tubes which
connect the ovaries to theuterus.
• Oophorectomy is the surgical removal of an ovary or
ovaries.
Indications
• Hysterectomy is often performed on cancer patients or to relieve
severe pelvic pain from things like,endometriosis or adenomyosis.
• Hysterectomy is also used as a last resort for
postpartumobstetrical haemorrhage or uterine fibroids that
causeheavy or unusual bleeding and discomfort in somewomen.
• Transsexuals undergoing sex reassignment surgery aspart of a
female-to-male (FTM) transition commonly havehysterectomies
and oophorectomies to remove theprimary sources of female
hormone production.
Pre-operative and post-operative care of client
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Before the patient is brought back to the
room, the scrub nursemakes sure that the
proper instruments and supplies areavailable
for the procedure. She opens the appropriate
sterilepacks and trays before scrubbing in to
organize and count them. After the patient is
brought back to the room and
anesthetized,she may perform the
abdominal and vaginal prep with an iodineor
chlorhexidine solution. She then gowns and
gloves the surgeons and helps with draping.
Informed consent.
Once the procedure is finished, the scrub nurse helps
thesurgeons clean the patient of prep solution and blood.
She thenassists in dressing the incision. The instruments
must be returnedto their trays and brought to the
decontamination room, while theoperating room is cleaned
and prepared for the next operation.
1. Determines patient’s immediate response to surgical
intervention.
2. Monitor patient’s physiologic status.
3. Assess patient’s pain level and administers appropriate
pain relief measures.
4. Maintains patient’s safety(airway, circulation, prevention
of injury)
5. Administer medication, fluid and blood component
therapy, ifprescribed.
6. Assess patient’s readiness for transfer to in hospital unit
or for discharge home based on institutional policy.
Skin prep, Special Instruments, supplies/equipments
• Put the patient’s legs in a
frog-like position and prepare
as forDilatation and Curettage,
• Insert a foley catheter and
connect to continuous
drainage.
• Return the patient’s leg to
their original position, and
replace the safety belt.
• For abdominal preparation
using iodine solution, begin at
theincision extending from
nipple to mid-thighs, and down
to the tablesat the sides
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Long, heavy Mayo scissors
Short and long weighted vaginal speculums with an extralong blade
Heaney right-angle retractors
Jorgenson scissors
Long Allis clamps
Deaver retractors.
A long needle holder
Heany clamps
Single tooth tenaculum
Single-tooth tenaculum
Bovie extender,
Suction apparatus
A neurosurgery headlight
Position of the patient on the operating table
• The operation is performed with
the patient in the supine position.
Some surgeons prefer a
modified lithotomy position using
Allen universal stirrups to allow
potential access to the vagina
and closer proximity of a second
assistant.
Proper draping of the patient for the patient
• Folded towel and a transverse or
laparotomy sheet
Type of anestheasia used
• Spinal anesthesia or General anesthesia.
Intraoperative Complications
• Bleeding - The most common sites of bleeding during vaginal hysterectomy
are uterine vessels, Utero-ovarian ligament, and vaginal cuff.
• Ureteral injury- The incidence of ureteral injury is about 0.5 percent.
• Bladder injury- The prevalence of bladder injury during vaginal hysterectomy
is up to 1.2 percent. It increases with risk factors like prior pelvic surgeries
and concomitant bladder surgery.
• Bowel injury- The risk is approximately 0.4 percent.
• Nerve injuries- Most commonly, the femoral nerve, peroneal, and tibial
nerves are affected by the retractors or by malposition of the legs on the
stirrups.
• Conversion to laparotomy- Instances like unexpected large pelvic masses,
adhesions, and hemorrhage unable to identify and control can increase the
chances of conversion to abdominal hysterectomy.
• Adverse reactions to anesthetics
Postoperative Complications
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Ileus
Bowel obstruction
Vaginal cuff dehiscence
Infections like vaginal cuff cellulitis and pelvic abscess
Fistulas-vesicovaginal, ureterovaginal, and rectovaginal fistulas
Prolapse of the pelvic structures like a Fallopian tube
https://www.youtube.com/watch?v=rvvjspbBghI
Transurethral Resection of the Prostate
(TURP)
Surgery to remove parts of the prostate gland
through the penis. No incisions are needed.
indications
• Morphological changes in bladder or upper urinary tract secondary to
bladder outlet obstruction, such as bladder diverticulum and
hydronephrosis.
• Constant and increasing postvoid residue greater than 100 ml.
• Recurrent urinary infection secondary to bladder outlet obstruction.
• Urodynamic findings and prostatic size alone are not absolute
indications for surgery. The final decision also depends on the patient’s
willingness for surgery.
Pre-operative and post-operative care of client
• Informed consent
• Stop aspirin 1 week before operation.
• Rule out and treat any urinary tract
infection by urine culture and
sensitivity.
• Thrombosis prophylaxis should best
arted the evening before operation (lo
w-molecu-lar-weight heparin).
• Rectal enema is used the day before
the operation.
• Intravenous single dose antibiotics are
started at induction.
- When the irrigation fluid
becomes clear, catheter traction
can be released up to 4-hr.
- Continue irrigation of the bladder
overnight.
- If there is no complication, t he
catheter can be removed 2-days
after operation.
Skin prep, Special Instruments, supplies/equipments
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Video camera with rotatable camera head (Olympus Visera).
100-ml bladder syringe.
20-Fr irrigation catheter.
Optional suprapubic catheter for continuous irrigation during
resection.
• Lubricant.
• Electrolyte-free and sterile irrigation fluid, positioned at a height
of 50–60 cm above the pubic symphysis.
Position of the patient on the operating table
• Patient is on a Lithotomy
position. 45 degrees
Type of anestheasia used
• Spinal anaesthesia (for the cooperative patient, maintain
in traopertaive communication with patient and provide
postoperative analgesia) or general anaesthesia.
Risk factors for complications
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Temporary difficulty urinating. You might have trouble urinating for a few days after the procedure. Until you can
urinate on your own, you will need to have a tube (catheter) inserted into your penis to carry urine out of your
bladder.
Urinary tract infection. This type of infection is a possible complication after any prostate procedure. An infection is
increasingly likely to occur the longer you have a catheter in place. Some men who have TURP have recurring
urinary tract infections.
Dry orgasm. A common and long-term effect of any type of prostate surgery is the release of semen during
ejaculation into the bladder rather than out of the penis. Also known as retrograde ejaculation, dry orgasm isn't
harmful and generally doesn't affect sexual pleasure. But it can interfere with your ability to father a child.
Erectile dysfunction. The risk is very small, but erectile dysfunction can occur after prostate treatments.
Heavy bleeding. Very rarely, men lose enough blood during TURP to require a blood transfusion. Men with larger
prostates appear to be at higher risk of significant blood loss.
Difficulty holding urine. Rarely, loss of bladder control (incontinence) is a long-term complication of TURP.
Low sodium in the blood. Rarely, the body absorbs too much of the fluid used to wash the surgery area during
TURP. This condition, known as TURP syndrome or transurethral resection (TUR) syndrome, can be life-threatening
if untreated. A technique called bipolar TURP eliminates the risk of this condition.
Need for re-treatment. Some men require follow-up treatment after TURP because symptoms don't improve or
they return over time. Sometimes, re-treatment is needed because TURP causes narrowing (stricture) of the urethra
or the bladder neck.
Immediate complications
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Hemorrhage
Air embolism
Apnea
Local damage on thyroid cartilage, cricoid cartillage,
recurrent laryngeal nerve
• cardiac arrest
• Pneumothorax, Pneumomediastinum.
• https://www.youtube.com/watch?v=aBelQBJNDNM