​Hysterectomy surgery steps

Women need to protect their bodies comprehensively so that they will not get sick. Common female diseases are gynecological diseases. These diseases have a great impact on women's bodies. Women with gynecological diseases need timely treatment. Otherwise, when the disease becomes serious, it will cause more diseases in women's bodies. Hysterectomy is common. What are the surgical steps for hysterectomy? The following is a detailed introduction.

Hysterectomy surgical steps:

Surgical procedures

(A) Incision: A midline incision is made in the lower abdomen from below the umbilicus to the upper edge of the pubic symphysis.

(ii) After suturing the infundibulopelvic ligament and round ligament and entering the abdominal cavity, exploration is performed to understand the extent of the lesion.

Use toothed hemostatic forceps to clamp the two horns of the uterus to pull and block the ascending branch blood flow of the uterine artery. Use No. 7 silk thread to suture the round ligament 2 to 3 cm away from the uterine horn, and double suture the pelvic infundibulum ligament slightly away from the pelvic wall (to avoid the ureter). The ovarian artery and venous plexus pass through the pelvic infundibulum ligament, which can be seen clearly under light and must be sutured tightly.

(III) Cutting the ligaments and incising the uterine bladder peritoneum

Lift the uterus and suture the sutures, cut the pelvic infundibulum ligament and round ligament. The blood flow to the uterus has been blocked at the uterine cornu, so only a small amount of blood will return when the ligament is cut, and generally no additional clamping is required to stop bleeding. Cut the anterior leaf of the broad ligament between the pelvic infundibulum ligament and the round ligament, free it forward, and cut the uterine bladder peritoneum and fold it to the opposite side (Figure 253).

(IV) Wandering Ion Palace Body

Use your fingers to gently separate the bladder slightly downward along the plane of loose connective tissue between the uterus and bladder to expose part of the cervix, and then slightly separate the tissues on both sides to expose the uterine artery and vein. The ureter passes below the blood vessels about 2 cm from the cervix. Then cut the posterior leaf tissue of the broad ligament on both sides of the uterine body to above the uterine artery. There is usually no bleeding during cutting, but the cutting should be done slightly away from the uterine body to avoid damaging the ascending branches of the uterine arteries near both sides of the uterine body. At this point, the uterus is completely free, with only a small amount of tissue on both sides connected to the vaginal vault.

(V) Wandering cervix

Use your hands to pull the uterus toward the head appropriately, and use your thumbs to push the bladder further below the level of the external cervical opening, while slowly pushing the ureters to both sides. If you pay attention and explore to both sides, you can feel a cord-like object sliding under your fingertips about 2 cm away from the cervix. This is the ureter. As long as the plane is accurate, pushing the bladder down will not be difficult and bleeding will not be excessive. If there are difficulties, it is usually related to the plane of entry being too deep, or it may be caused by inflammatory adhesions. It should be clarified before separation. Sharp dissection can be performed if necessary. It is of positive significance to avoid damaging the ureter by palpating the location of the ureter and then dealing with the tissues on both sides of the cervix.

(6) Hysterectomy

Place a gauze pad in the rectouterine pouch to absorb any discharge that may leak from the vagina. Lift the uterus, cut the anterior vaginal fornix, clamp and lift the anterior vaginal wall, and insert a small piece of gauze through the incision to prevent the accumulated fluid in the vagina from flowing out and contaminating the pelvic cavity (Figure 261). Then clamp the anterior lip of the cervix and lift it upwards, cut it along the vaginal vault, and remove the uterus (Figure 262). When circumcising the vaginal vault, always be sure to lift the cervix to facilitate cutting without contacting the surrounding area to prevent contamination (Figure 263). After each incision, the vaginal stump is clamped to reduce bleeding and provide traction to facilitate suturing after hysterectomy.

Any instrument that has come into contact with the vagina should be placed in a contaminated basin immediately after use.

(VII) Suturing the vaginal stump and pelvic peritoneum

After the uterus is removed, the vaginal stump is smeared with iodine and alcohol cotton balls, and then No. 1 or No. 2 chromium gut sutures are used to make "8"-shaped interrupted sutures or continuous sutures. Be careful to sew the two corners of the broken end. Finally, carefully check the thickness and peristalsis of the ureters on both sides and whether there is bleeding at the suture points. If there is no abnormality, the pelvic peritoneum is sutured continuously first, and then the abdominal cavity is closed routinely. After the operation, remove the gauze from the vagina.

In addition, regarding the issue of sexual life after surgery, some women who need to undergo hysterectomy due to certain gynecological diseases often have many concerns, one of which is the worry that the surgery will affect their sexual life. In fact, this idea is unnecessary. Generally, hysterectomy is done by cutting off the vaginal vault and suturing the top of the vagina to form a blind end. The vagina retains its original structure after the operation, unless a malignant tumor requires the removal of a longer vagina, which will shorten the vagina after the operation. Generally, hysterectomy does not affect the length or function of the vagina, so the operation has no effect on sexual life. Even if the vaginal resection is longer, if the couple can understand and cooperate with each other, they can still have a satisfactory sex life.

After understanding the surgical steps of a hysterectomy, when a hysterectomy is performed, it should be performed according to the above method. However, when undergoing such an operation, women must pay attention to undergoing various physical examinations so that they can have some understanding of their own uterine problems and will not choose the wrong method during treatment.