Excision of the uterus with appendages - ovarian cancer
Laying the patient on her back.
Anesthetizing the patient according to procedure.
Inserting a bladder catheter.
Decontaminating the surgical field.
Draping the surgical field with drapes.
In the median line, the abdominal skin is incised from the pubic conjunctiva to the umbilicus, with the possibility of extending the cut above the umbilicus.
The abdominal skin is cut in layers.
The condition of the reproductive organs and the condition of the abdominal organs are assessed, paying particular attention to:
Presence of fluid in the abdominal cavity- evaluate the amount, color and nature of the fluid and collect fluid from the sinus of Douglas and from the subdiaphragmatic area for cytological examination. If there is no fluid in the abdominal cavity, cytological smears should be taken from the subdiaphragmatic area and from the sinus of Douglas, and the peritoneal cavity should be flushed with fluid, which should be taken for cytological examination.
Appearance of the tumor, its relation to adjacent organs, the condition of the capsule, the presence of growths on the capsule.
Appearance of the uterus, fallopian tubes, fistulae.
Appearance of the greater web.
Condition of the liver- consistency, external surface, edge of the lobes, gallbladder.
Condition of the subperitoneal region of the peritoneum.
Palpation of the lymph nodes, aortic and iliac nodes.
Condition of the mural peritoneum.
Condition of the intestinal peritoneum.
Appearance of the appendix and mesentery of the colon. The obturator ligaments are pricked and transected bilaterally. The funnel-pelvic ligaments are pricked and transected. The anterior lamina of the uterine broad ligament is incised and the peritoneum of the vesicoureteral fold is incised transversely. The blunt sliding of the bladder-uterine kink together with the bladder downward to the level of the vaginal vaults is carried out. Slide bluntly the bladder-uterine fold together with the bladder downward, up to the height of the vaginal vault. Mikulicz forceps are placed on the parametrium tissues on both sides of the uterus, the tissues are cut and pricked, and then the Mikulicz forceps are removed. Gradually ligate and transect the tissues of the parametrium, including the uterine artery, reaching the lateral vaginal vaults. The sacro uterine ligaments are ligated and transected on both sides. After reaching the height of the lateral vaginal vaults, Mikulicz forceps are inserted and the lateral vaginal vaults are incised. After opening the vagina, the uterus along with the adnexa is cut away from the vaults. After placing figure-eight sutures on the corners of the vagina, the vagina is sewn up with single sutures. The obturator ligaments are sewn into the top of the vagina. At the clamps, the ligaments are ligated gradually and the greater web is removed in its entirety. Specimens are taken from suspicious areas (wall peritoneum, adhesions) for histopathological examination. If part of the tumor is left in the abdominal cavity, the size of the tumor should be determined. After making sure that the hemostasis of the operated site is normal, the abdominal cavity is closed. Continuous suture to the peritoneum, single sutures to the muscles, fascia and subcutaneous tissue.
Anesthetizing the patient according to procedure.
Inserting a bladder catheter.
Decontaminating the surgical field.
Draping the surgical field with drapes.
In the median line, the abdominal skin is incised from the pubic conjunctiva to the umbilicus, with the possibility of extending the cut above the umbilicus.
The abdominal skin is cut in layers.
The condition of the reproductive organs and the condition of the abdominal organs are assessed, paying particular attention to:
Presence of fluid in the abdominal cavity- evaluate the amount, color and nature of the fluid and collect fluid from the sinus of Douglas and from the subdiaphragmatic area for cytological examination. If there is no fluid in the abdominal cavity, cytological smears should be taken from the subdiaphragmatic area and from the sinus of Douglas, and the peritoneal cavity should be flushed with fluid, which should be taken for cytological examination.
Appearance of the tumor, its relation to adjacent organs, the condition of the capsule, the presence of growths on the capsule.
Appearance of the uterus, fallopian tubes, fistulae.
Appearance of the greater web.
Condition of the liver- consistency, external surface, edge of the lobes, gallbladder.
Condition of the subperitoneal region of the peritoneum.
Palpation of the lymph nodes, aortic and iliac nodes.
Condition of the mural peritoneum.
Condition of the intestinal peritoneum.
Appearance of the appendix and mesentery of the colon. The obturator ligaments are pricked and transected bilaterally. The funnel-pelvic ligaments are pricked and transected. The anterior lamina of the uterine broad ligament is incised and the peritoneum of the vesicoureteral fold is incised transversely. The blunt sliding of the bladder-uterine kink together with the bladder downward to the level of the vaginal vaults is carried out. Slide bluntly the bladder-uterine fold together with the bladder downward, up to the height of the vaginal vault. Mikulicz forceps are placed on the parametrium tissues on both sides of the uterus, the tissues are cut and pricked, and then the Mikulicz forceps are removed. Gradually ligate and transect the tissues of the parametrium, including the uterine artery, reaching the lateral vaginal vaults. The sacro uterine ligaments are ligated and transected on both sides. After reaching the height of the lateral vaginal vaults, Mikulicz forceps are inserted and the lateral vaginal vaults are incised. After opening the vagina, the uterus along with the adnexa is cut away from the vaults. After placing figure-eight sutures on the corners of the vagina, the vagina is sewn up with single sutures. The obturator ligaments are sewn into the top of the vagina. At the clamps, the ligaments are ligated gradually and the greater web is removed in its entirety. Specimens are taken from suspicious areas (wall peritoneum, adhesions) for histopathological examination. If part of the tumor is left in the abdominal cavity, the size of the tumor should be determined. After making sure that the hemostasis of the operated site is normal, the abdominal cavity is closed. Continuous suture to the peritoneum, single sutures to the muscles, fascia and subcutaneous tissue.
