Rutzki S.
Gabriel
NCM 105
TAHBSO
Stands for total abdominal hysterectomy and bilateral salphingo-oophorectomy.
It is a surgical procedure involving the removal of the uterus, both ovaries, and the
fallopian tubes through an incision in the abdomen. The lymph nodes in the pelvis may
also be removed. You usually get a general anesthetic for this procedure.
The removal of an ovary together with a fallopian tube is called a salpingo-
oophorectomy or unilateral salpingo-oopherectomy (USO). When both ovaries and
both tubes are removed, the term bilateral salpingo-oophorectomy (BSO) is used.
Oophorectomy and salpingo-oophorectomy are not common forms of birth control in
humans; more usual is tubal ligation , in which the Fallopian tubes are blocked but the
ovaries remain intact. Removal of the ovaries in women is the biological equivalent of
castration (surgical excision of one or both testicles or ovaries) in males.
Hysterectomy in the literal sense of the word means merely removal of the uterus,
however other organs such as ovaries, fallopian tubes and the cervix are very frequently
removed as part of the surgery.
Types of Hysterectomy
• Radical hysterectomy : complete removal of the uterus, cervix, upper vagina, and
parametrium. Indicated for cancer. Lymph nodes, ovaries and fallopian tubes are
also usually removed in this situation.
• Total hysterectomy : Complete removal of the uterus and cervix.
• Subtotal hysterectomy : removal of the uterus, leaving the cervix in situ.
Adverse effects
• Mortality - associated with significantly and substantially increased all causes
long term mortality except when performed for cancer prevention.-
• Cardiovascular risk - When the ovaries are removed a woman is at a seven times
greater risk of cardiovascular disease,
• Osteoporosis - Reduced levels of testosterone in women is predictive of height
loss, which may occur as a result of reduced bone density with an increased risk
of osteoporosis and bone fractures.
• Adverse effect on sexuality - Substantially more women reported libido loss,
difficulty with sexual arousal, vaginal dryness
Lose most of their ability to produce the hormones estrogen and progesterone, and
lose about half of their ability to produce testosterone, and subsequently enter what is
known as "surgical menopause.
INDICATIONS FOR PROCEDURE:
• The patient recently presented with postmenopausal bleeding and was found to
have a Grade II endometrial carcinoma on biopsy.
• uterine sarcoma (cancerous tumor).
• endometrial cancer
• ovarian cysts or cancer
FINDINGS: Examination under anesthesia revealed a small uterus with no nodularity.
During the laparotomy, the uterus was small, mobile, and did not show any evidence of
extrauterine spread of disease. Other abdominal viscera, including the diaphragm, liver,
spleen, omentum, small and large bowel, and peritoneal surfaces, were palpably normal.
There was no evidence of residual neoplasm after removal of the uterus. The uterus itself
showed no serosal abnormalities and the tubes and ovaries were unremarkable in
appearance.
PROCEDURE: The patient was brought to the Operating Room with an IV in place.
Anesthesia was induced, after which she was examined, prepped and draped.
A vertical midline incision was made and fascia was divided. The peritoneum was
entered without difficulty and washings were obtained. The abdomen was explored with
findings as noted. A Bookwalter retractor was placed and bowel was packed. Clamps
were placed on the broad ligament for traction. The retroperitoneal spaces were opened
by incising lateral and parallel to the infundibulopelvic ligament. The round ligaments
were isolated, divided, and ligated. The peritoneum overlying the vesicouterine fold was
incised to mobilize the bladder.
Retroperitoneal spaces were then opened, allowing exposure of pelvic vessels and
ureters. The infundibulopelvic ligaments were isolated, divided, and doubly ligated. The
uterine artery pedicles were skeletonized, clamped, divided, and suture ligated.
Additional pedicles were developed on each side of the cervix, after which tissue was
divided and suture ligated. When the base of the cervix was reached, the vagina was
cross-clamped and divided, allowing removal of the uterus with attached tubes and
ovaries. Angle stitches of o-Vicryl were placed, incorporating the uterosacral ligaments
and the vaginal vault was closed with interrupted figure-of-eight stitches. The pelvis was
irrigated and excellent hemostasis was noted.
Retractors were repositioned to allow exposure for lymphadenectomy. Metzenbaum
scissors were used to incise lymphatic tissues. Borders of the pelvic node dissection
included the common iliac bifurcation superiorly, the psoas muscle laterally, the cross-
over of the deep circumflex iliac vein over the external iliac artery inferiorly, and the
anterior division of the hypogastric artery medially. The posterior border of dissection
was the obturator nerve, which was carefully identified and preserved bilaterally.
Ligaclips were applied where necessary. After the lymphadenectomy was performed
bilaterally, excellent hemostasis was noted.
Retractors were again repositioned to allow exposure of para-aortic nodes. Lymph node
tissue was mobilized, Ligaclips were applied, and the tissue was excised. The pelvis was
again irrigated and excellent hemostasis was noted. The bowel was run and no evidence
of disease was seen.
All packs and retractors were removed and the abdominal wall was closed using a
running Smead-Jones closure with #1 permanent monofilament suture. Subcutaneous
tissues were irrigated and a Jackson-Pratt drain was placed. Scarpa's fascia was closed
with a running stitch and skin was closed with a running subcuticular stitch. The final
sponge, needle and instrument counts were correct at the completion of the procedure.
The patient was then awakened from her anesthetic and taken to the Post Anesthesia Care
Unit in stable condition.
