Surgical Techniques in Radical Hysterectomy

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Questions and Answers

Which type of surgical approach requires a minor count for initial, closing, and final counts?

Vaginal (correct)

Combined Laparoscopic and Vaginal

Open

Laparoscopic

Which instrument is primarily used to grasp the cervix during a vaginal approach?

Weighted speculum

Uterine sound

Ovum forceps

Tenaculum (correct)

What type of count is required when the cervix is removed during a surgical procedure?

Initial Count (minor)

Closing Vault Count (major)

Final Count (major)

Closing Vault Count (minor) (correct)

Which of the following instruments is commonly used during an open hysterectomy?

Heaney hysterectomy forceps Signup and view all the answers

Considering equipment used in laparoscopic surgeries, which of the following poses a risk of hypothermia?

Forced-Air Warming Blankets Signup and view all the answers

Which instrument set is typically required for all open, laparoscopic, or combined cases?

D and C set Signup and view all the answers

What is a common tool used for measuring the depth of the uterus in vaginal surgery?

Uterine sound Signup and view all the answers

In which surgical approach is a major count needed during the closing of the procedure?

Open Signup and view all the answers

Which ligaments are essential for the support of the uterus?

Broad, round, cardinal, and uterosacral ligaments Signup and view all the answers

What is the main function of the fallopian tubes?

Transport ova to the uterus from the ovaries Signup and view all the answers

Which condition might indicate the need for gynecological surgery?

Benign tumours or abnormal bleeding Signup and view all the answers

Where does ectopic pregnancy typically occur?

In the fallopian tube Signup and view all the answers

What part of the cervix protects the entrance to the uterus?

Internal os and external os Signup and view all the answers

Why is a patient-centered holistic approach important in gynecological perioperative care?

To address the unique emotional and physical needs of the patient Signup and view all the answers

What anatomical structure connects the cervix to the bladder?

Supravaginal portion Signup and view all the answers

What type of surgical approach is commonly used to repair a ruptured fallopian tube due to ectopic pregnancy?

Laparoscopic surgery Signup and view all the answers

What is the primary purpose of a cervical cerclage?

To prevent mid-trimester miscarriages Signup and view all the answers

Which surgical count is required for cervical cerclage procedures?

Small count Signup and view all the answers

What surgical technique involves the placement of a purse-string suture at the internal os?

Shirodkar Technique Signup and view all the answers

What is a significant risk associated with performing surgery on pregnant patients?

Fetal asphyxia Signup and view all the answers

During a cesarean delivery, how should the mother be positioned to alleviate pressure on the uterus?

With a wedge under the left hip Signup and view all the answers

What is a common complication of aggressive cervical cancer in women aged 40-65?

It is often diagnosed late due to being asymptomatic Signup and view all the answers

Which medication is commonly used to decrease uterine activity during surgery on pregnant patients?

Terbutaline Signup and view all the answers

What does cervical cerclage specifically aim to prevent during pregnancy?

Incompetence of the cervix leading to miscarriages Signup and view all the answers

What is the purpose of the ovaries in the female reproductive system?

To facilitate the implantation of the fertilized ovum and embryo development Signup and view all the answers

What is a common complication that may require surgical intervention involving the ovaries?

Ovarian cysts Signup and view all the answers

Which part of the vagina is adjacent to the rectum?

Posterior wall Signup and view all the answers

What must be assessed in a patient during gynecological nursing assessment?

Gynecological history including Pap smears and HPV testing Signup and view all the answers

What patient positioning is typical for open hysterectomies?

Supine with Trendelenburg tilt Signup and view all the answers

Why is it important to ensure that stirrups are fastened during a procedure?

To provide support and prevent leg injuries Signup and view all the answers

What is a key consideration regarding patient leg positioning in lithotomy position?

Hips should not be flexed greater than 90 degrees Signup and view all the answers

What is a perioperative nursing consideration regarding blood products?

Orders and availability must be confirmed pre-, intra-, and post-operatively Signup and view all the answers

What is the primary reason for keeping cervical instruments isolated during surgery?

To prevent contamination Signup and view all the answers

What type of sutures are typically used in gynecological surgeries?

Large size and absorbable sutures Signup and view all the answers

Which of the following is involved in a Radical Hysterectomy?

Uterus, cervix, fallopian tubes, ovaries, and recognizable lymph nodes Signup and view all the answers

What is typically required for a major surgical count?

Full counts at both the beginning and end of the procedure Signup and view all the answers

In which age group are ovaries usually preserved during a Total Abdominal Hysterectomy (TAH) with Bilateral Salpingo-Oophorectomy (BSO)?

Women under 45 years old Signup and view all the answers

What complication may arise due to extensive dissection during gynecologic surgery?

Vesicovaginal fistula Signup and view all the answers

What does a Pelvic Exenteration involve removing?

Entire reproductive system and rectum Signup and view all the answers

What is a significant risk factor for ovarian cancer treatment after radiation therapy?

Metastasis to omentum Signup and view all the answers

Study Notes

Learning Outcomes

Understand relevant anatomy and procedural aspects of gynecological surgeries.
Distinguish between minimally invasive and open surgical procedures.
Familiarize with clinical pathways for obstetrical patients undergoing surgery.
Identify conditions necessitating gynecological surgeries such as abnormal bleeding, tumors, and infertility.
Emphasize patient-centered holistic approaches in perioperative care.

Anatomy Overview

Cervix
- Supravaginal portion near bladder and ureters; vaginal portion extends into the vaginal vault.
- Contains internal and external os, protecting the uterus.
Uterus
- Pear-shaped organ situated between bladder and rectum.
- Supported by ligaments: broad, round, cardinal, uterosacral, and levator ani muscles.
Fallopian Tubes
- Musculomembranous channels (10-13 cm) delivering ova from ovaries to the uterus.
- Supported by infundibulopelvic ligament; critical relationships with cecum, appendix, and sigmoid flexure.
Ovaries
- Positioned on either side of the uterus, essential for ovum implantation and embryo development.
- Ovarian cysts may necessitate surgical intervention (cystectomy).
Vagina
- Musculomembranous tube functions in menstruation, sexual intercourse, and childbirth.
- Has anterior wall close to bladder and urethra; posterior wall adjacent to rectum.

Perioperative Nursing Considerations

Nursing Assessment
- Comprehensive gynecological history, including Pap smears, HPV, past surgeries, and menstrual history.
- Assessment of patient’s pain tolerance for post-operative pain management.
Blood Management
- Anticipation of blood transfusion needs due to tissue dissection in vascular areas.
- Preparation of hemostatic agents for surgical emergencies.
Patient Positioning
- Surgical position varies: supine with slight Trendelenburg for open surgeries; lithotomy for laparoscopic procedures.
- Care in positioning to avoid nerve injury; proper process for removing legs from stirrups post-surgery.

Instrumentation and Surgical Counts

Surgical Approaches
- Types: Vaginal, Open, Laparoscopic, LAVH (Laparoscopically Assisted Vaginal Hysterectomy).
Instrument Sets
- Common instruments for vaginal procedures include weighted speculum, tenaculum, and uterine curettes.
- Open and laparoscopic procedures require basic laparotomy sets, hysteroscopes, and specialized forceps.
Surgical Counting
- Minor counts for vaginal procedures; major counts for open and laparoscopic surgeries, including vault counts if indicated.

Equipment and Surgical Counts

Equipment Use
- Forced-air warming blankets to prevent hypothermia; operating table adjustments as needed.
- Use of endometrial ablation equipment with care around the cervix.
Surgical Counts
- Full counts for major procedures, minor counts for closing vaults. Accurate counts essential to prevent retained instruments.

Radical Hysterectomy and BSO

Radical Hysterectomy (Wertheim)
- Involves extensive removal of reproductive organs and lymph nodes, requiring deep dissection.
Bilateral Salpingo-Oophorectomy (BSO)
- Fallopian tubes and part or all of ovaries removed, with preservation typically for women under 45.

Vaginovaginal Fistula and Exenteration

Vesicovaginal Fistula
- Abnormal opening between bladder and vagina leading to urine leakage; post-operative injuries can cause this.
Pelvic Exenterations
- Comprehensive removal of pelvic organs, performed for advanced cancers; types include complete, anterior, and posterior.

Obstetrical Surgery Considerations

Challenges include monitoring both mother and fetus during surgery.
Importance of fetal heart rate monitoring, rapid anesthetic induction, and tocolytic medication availability.
Cervical cerclage performed to prevent miscarriage in cases of cervical incompetence; techniques can be vaginal or abdominal/laparoscopic.

Cervical Cerclage Techniques

Shirodkar Technique
- Placement of a suture to mechanically support the cervix; can be removed in office around 36 weeks or at time of scheduled C-section.

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Description

This quiz focuses on the surgical techniques and precautions involved in radical hysterectomy, including the handling of instruments, sutures, and the importance of surgical counts. Understanding these aspects is crucial for ensuring patient safety and operative success in gynecological surgeries.