Explain: Subtotal Hysterectomy

Content:

Clinical Information:

_{The year-old female patient had a chief complaint of [[ menorrhagea, dysmenorrhea, anemia, lower abdomianl pain, compression syndrome, myoma in rapid progression, infertility, repeat abortion ]].} Abdominal subtotal hysterectomy

and {{no, right, left, bilateral}} salpingo-oophorectomy,{{no, right, left, bilateral}} Oophorectomy, {{no, right, left, bilateral}} Salpingectomy, {{no, right, left, bilateral}} Enucleation of ovarian cyst.was performed. In addition, [[Lysis of adhesion, Incidental appendectomy]] was/were also performed during this surgery.

Operative Procedures:

Under general anesthesia, IV drip with IC needle, on Foley, the patient was put in supine position. The abdominal wall was cleaned with soap and alcohol betadine. Prophylactic antibiotics [Cefamezine, Zinacef] was given immediately before the operation. The abdominal wall was opened with {{ subumbilical longitudinal, pfannestial }} incision. The operative field was exposed with self retaining retractor and large wet gauze packing. There are myomas over the fundal and corpus area of the uterus. _{Bilateral round ligaments were severed and both anterior and posterior broad ligaments were incised over the ovarian ligament posteriorly and close to the bladder reflection at the isthmus level anteriorly. The infundibulo-pelvic ligaments or ovarian ligaments were clamped and ligated depending on salpingo-oophorectomy or not. The posterior broad ligament were further incised downward until the upper ends of uterosacral ligaments was reached. Then the bladder base was mobilized downward carefully to expose the cervico-vesicle fascia and the lower margin of cervix. Bilateral ascending branches of uterine artery were clamped and dissected with double ligations. Then the isthmus of the cervix were wedgely incised after careful separation of bladder pillars laterally. The cuff was closed by continued 1-0 vicryl suture. After hemostasis, peritoneal defect was closed by approximate the bladder serosal edge to the peritoneum over the stump. Bilateral round ligaments were sutured together with the vaginal stump.} The peritoneum below the umbilicus was approximated by 1-0 chromic catgut, the abdominal fascia was closed by 1-0 vicryl continuous suture, the sub-cutaneous fat was approximated by 1-0 vicryl, and the skin was approximately by 3-0 vicryl subcutaneously. The patient was sent to POR intensive care unit for recovery and respiratory support.