Supravaginal amputation of the uterus
Last reviewed: 23.04.2024
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After opening the abdominal cavity, the uterus should be removed to the wound as far as possible.
Attach clamps on the round ligament of the uterus, the own ligament of the ovaries and the fallopian tubes in such a way that the first of them is located close to the uterus, and then, retreating 1-1.5 cm from the lateral surface of the uterus, grip the clamps with a round ligament, own ovarian ligament and uterine pipe. If the fallopian tubes are removed, the clamps are placed on the mesosalpinx. Ligaments cross and ligate.
Own ovaries and the uterine tube are crossed. After crossing these formations, they are ligated with synthetic filaments and the ligature is taken to the clamp.
The bladder-uterine fold is opened from one round ligament to the other. After opening, the vesicle-uterine fold is cut off in an obtuse and acute way along with the bladder. Isolate the vascular bundles on both sides, they are clamped in such a way that the edge of the clamp captures the tissue of the cervix and slides off it. Vascular bundles cross, pierce, ligate with synthetic threads. The body of the uterus is cut off from the neck by a scalpel. The scalpel when cutting the cervix should be directed so that a triangular incision is formed with the apex of the inner pharynx. The edges of this section are well closed when applying seams.
When the cervix is cut off after the incision of its anterior part, the stump is taken to the clamp. After clipping the stump, the cervix is treated with an alcohol solution of iodine or ethyl alcohol with a touch of a tampon. On the cervix, three or four sutures are applied with a synthetic absorbable material to avoid the appearance of ulcers around the ligatures on the cervix
Then, peritonization is performed by the leaves of the broad ligament of the uterus and the peritoneum of the vesicle-uterine fold, imposing a linear or sutured suture, with immersing the stumps of the round ligaments and appendages in the suture.
Check and drain the abdominal cavity. Sew the anterior abdominal wall.
Extirpation of the uterus
Before delivering the patient to the operating room, the vagina and cervix are treated with a solution of brilliant green. In the bladder, a permanent catheter is left for the duration of the operation.
After opening the abdominal cavity, the uterus should be removed to the wound as far as possible.
Attach clamps on the round ligament of the uterus, the own ligament of the ovaries and the fallopian tubes in such a way that the first of them is located close to the uterus, and then, retreating 1-1.5 cm from the rib of the uterus, grip the clamps with a round ligament, own ovarian ligament and uterine tube . If the fallopian tubes are removed, the clamps are placed on the mesosalpinx.
When leaving the appendages of the uterus, separate clamps are placed on the round ligament, uterine tube and own ovarian ligament. Ligaments dissect and ligate. When removing the appendages, the clamps are placed on the funnel-hip and round ligaments. After the application of the clamps on the lateral surfaces of the uterus, dissect sheets of broad ligaments, then the peritoneum of the vesicle-uterine cavity near the transitional fold. The bladder is separated from the cervix and moved to the area of the vaginal vault.
The uterus is pulled to the left and, if possible, the vascular bundle is extracted from the fiber in the direction of its lateral surface, previously dissecting the posterior leaf of the broad ligament to the level of the internal pharynx. On the vascular bundle, a clamp is placed perpendicular to the artery in the cervix. The counterclamme is placed on the vessels 0.5 cm above the first clamp. The vascular bundle is dissected and ligated, the ends of the ligatures are cut off. Then the same manipulation is performed on the other side.
After ligation and crossing of the vessels, the uterus is drawn to the womb and the sacrum-uterine ligaments near the place of their separation impose clamps perpendicular to the uterus (in order not to grab the ureter). Sacral-uterine ligaments cross and ligate.
After making sure that the cervix is sufficiently allocated, the uterus is pulled upward, and the excised bladder is pushed back by the mirror, exposing the vaginal wall in the region of the anterior arch. The anterior vaginal fornix is grasped with a clamp and opened with scissors or a scalpel. In the vagina a gauze swab moistened with a solution of antiseptic is administered (it is removed on the operating table after the end of the operation). Then the uterus is cut off from the vaginal vaults. The edges of the incision of the vaginal vaults are seized with long clamps. The front wall of the vagina is lined with a leaf of the vesicle-uterine fold with separate sutures. The back wall of the vagina is sheathed, connecting it with the peritoneum of the rectum-uterine cavity. The stems of the ligament on both sides are wrapped in the sutures into a parameter. In this case, the vagina remains open and plays the role of natural drainage. It is not necessary to expect that this drainage will last for a long time, since a maximum of 12 hours will glue the walls of the vagina. It is possible to tightly sew up the vagina and over this suture to connect the peritoneum of the vesicle-uterine fold and the rectum-uterine cavity.
Check and drain the abdominal cavity. Sew the anterior abdominal wall.
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