Summary of "Total Abdominal Hysterectomy | Atlas of Gynecologic Surgery"

Main Ideas and Concepts

The video provides a detailed surgical guide on performing a Total Abdominal Hysterectomy (TAH), particularly in the context of resecting a large right ovarian neoplasm. It outlines the surgical approach, techniques, and steps involved in the procedure, emphasizing the importance of careful dissection, ligation, and securing of various anatomical structures.

Key Steps in Total Abdominal Hysterectomy

Incision Selection:
- Choose between a transverse or vertical incision based on clinical factors and the scope of the operation.
- A vertical midline incision is preferred for flexibility and potential extension.
Exposure and Identification:
- Deliver the ovarian mass through the incision and expose the pelvis.
- Identify and suture ligate the round ligament laterally.
- Place a vascular Hema clip medially to control bleeding.
Resection of Ovarian Mass:
- Divide the round ligament to facilitate the resection.
- Skeletonize the utero-ovarian ligament and fallopian tube pedicle with a back cut incision.
- Identify the external iliac artery and locate the ureter at the pelvic brim.
Clamping and Isolation:
- Open the avascular space of Graves to define ovarian vessels.
- Double clamp the utero-ovarian ligament and fallopian tube complex to isolate the vascular supply.
- Divide both pedicles and send the adnexal mass for frozen section diagnosis.
Securing Pedicles:
- Use suture ligatures to secure the infundibulum pelvic ligament pedicle.
- Ligate the uterine side pedicle with a Haney transfixion stitch for added security.
Displacing Structures:
- Place a self-retaining retractor and pack the bowel out of the pelvis.
- Grasp the uterus and explore the pelvic sidewall, developing the para-rectal space.
Contralateral Adnexectomy:
- Confirm the ureter's position and create a window in the avascular space.
- Clamp, divide, and suture ligate the infundibulum pelvic ligament.
Uterine Vessel Management:
- Clear surrounding peritoneum from the uterine vessels.
- Secure the uterine vessels with curved and straight clamps, then divide and ligate the uterine pedicle.
Cardinal ligament Division:
- Place a Haney clamp across the Cardinal ligament and confirm the bladder's position.
- Divide and suture ligate the Cardinal ligament.
cervical-vaginal junction:
- Dissect the bladder off the proximal vagina and locate the cervix.
- Create an anterior colpotomy and use curved clamps to secure and divide the cervical-vaginal junction.
Final Steps:
- Excise the specimen, secure the posterior pedicle, and close the vaginal cuff with figure-of-eight sutures.

Conclusion

The video emphasizes a methodical approach to TAH, focusing on anatomical landmarks, careful dissection, and securing of tissues to ensure a successful surgical outcome.