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 • • 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 • • • • • • • • • • • • • 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 • • • • • • • 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 • • • • 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 • • • • • • • • 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 • • • • 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