I am Dabasmita Chakrabarti  I am a member of Signature Ob/Gyn practicing at Howard County General Hospital.

We are a member of the Johns Hopkins family of physicians.

abdominal hysterectomy with bilateral salpingo-oophorectomy

Wonderful abdominal hysterectomy bilateral salpingo-oophorectomy An abdominal hysterectomy is an operation to remove the uterus and the cervix.

There are a variety of reasons why women would need a hysterectomy.

Pelvic pain, irregular or heavy periods, fibroids, endometriosis are common reasons why women need an abdominal hysterectomy.

It is also done as a treatment for cancer of the gynecologic organs.

Patients who are transgender will also request an abdominal hysterectomy as part of their gender-affirming transition.

I would say the strongest factor in their quality of life.

total abdominal hysterectomy with bilateral salpingo-oophorectomy

Obviously, if someone has cancer then there often isn’t any other option. But when an abdominal hysterectomy is done for non-cancerous reasons,

almost always we have tried much more conservative methods first and when those don’t work and people are suffering from pain or bleeding then an abdominal hysterectomy can be a curative procedure.

It can be absolutely life-changing. So, a hysterectomy is a removal just of the uterus and the cervix.

The ovaries are what produce hormones and it’s the loss of ovarian function that results in menopause.

So when we do an abdominal hysterectomy, we don’t remove the ovaries unless there is a very good reason for it.

So just removing the uterus does not cause menopause.

When doing a hysterectomy, we typically will recommend that the fallopian tubes also be removed.

Recent studies have shown that about 50-60 percent of ovarian cancers actually start in the fallopian tubes.

The removing them we can lower a woman’s lifetime risk of ovarian cancer.

This does not affect her ovaries, or menopause, or her hormonal functioning and is a huge benefit from the hysterectomy.

what not to do after a hysterectomy

There are three different ways to perform a hysterectomy.

• It can be done with a fairly large abdominal incision,
• similar to that of a cesarean section,
• it can be done vaginally where the incisions are just in the vagina or it can be done laparoscopically,
• that means with several very small incisions in the abdomen.

The recovery from a minimally-invasive hysterectomy which means one done either with small incisions or through the vagina

so there is no abdominal incision that is generally not too bad.

Women go home from the hospital the next day,

they are achy and sore for the next few days and tired for a couple of weeks, but they really do fine with Tylenol and ibuprofen afterward.

signs you need a hysterectomy

Some women can go back to work in two weeks if they have a job that doesn’t require any heavy lifting.

• With an abdominal hysterectomy,
• that means the larger incision,
• recovery is a little bit longer and a little more difficult.
• Often women can go home till the next day,
• sometimes they stay two days in the hospital,
• but will take them longer to bounce back.

Many women are concerned about their sex life before and after an abdominal hysterectomy.

• In general,
• if one has a good sex life before an abdominal hysterectomy,
• you will have a good sex life after a hysterectomy.

It does not affect orgasms or how intercourse feels and many women find intercourse to be much more pleasurable after their problem has been taken care of.

Total Abdominal Hysterectomy and  Atlas of Gynecologic Surgery

total abdominal hysterectomy can be performed through either a transverse or vertical incision depending on clinical factors or

the anticipated scope of the operation in this case hysterectomy accompanies resection of a large right ovarian neoplasm and

the vertical midline incision offers

the greatest flexibility and can be extended above the umbilicus if necessary the ovarian mass is delivered through the incision and

the pelvis exposed the round ligament is identified and suture ligated laterally a vascular Hema clip is placed medially to control back bleeding and

the round ligament is divided to facilitate resection of the ovarian mass

the utero ovarian ligament fallopian tube pedicle is skeletonized with a back cut incision parallel to the round ligament toward the uterine fundus

the incision in the broad ligament peritoneum is extended toward

the pelvic brim parallel to the infundibular pelvic ligament

the external iliac artery is identified on

the medial surface of the psoas muscle the ureter is attached to the medial leaf of the broad ligament peritoneum and is most easily located at the pelvic brim the avascular space of graves is opened in the medial leaf of the broad ligament defining

the ovarian vessels in the infundibulum pelvic ligament which is doubly clamped the utero ovarian ligament fallopian tube complex is similarly double clamped effectively isolating the vascular supply of

the right adnexal mass both pedicles are divided and the adnexal Masek sized and sent for frozen section diagnosis you the infundibulum pelvic ligament pedicle is secured with a suture ligature while the more substantial pedicle on the uterine side is ligated with a Haney trans fiction stitch for added security you a self-retaining retractor can now be placed and

the bowel packed out of the pelvis the uterus is grasped and placed on tension exposing the broad ligament peritoneum

the pelvic sidewall is explored developing

the pararectal space with identification of the ureter on the medial lief of the broad ligament peritoneum the round ligament is skeletonized and the anterior broad ligament opened down to

the vesicle uterine peritoneal reflection the round ligament is suture ligated and divided facilitating additional upward displacement of

the uterus you the vesikko uterine peritoneal incision is extended and the vesikko cervical space or bladder flap developed with sharp dissection your attention is directed toward

the contralateral ad NEX ectomy the position of the ureter is confirmed and a window is created in the avascular space of graves you with the ureter under direct visual the infundibulum pelvic ligament is doubly clamped divided and suture ligated you the specimens

I’d pedicle of

• the infundibulum pelvic ligament is ligated and tied to
• the clamp manipulating
• the uterus to keep
• the adnexa out of
• the field of dissection during hysterectomy you
• the bladder is further mobilized off of
• the cervix and proximal vagina you

the uterus is placed on contralateral traction and the uterine vessels are cleared of surrounding peritoneum and a reel or tissue you the uterine vessels are secured with a curved Hany clamp placed perpendicular to

the long axis of the uterus at the level of the uterine isthmus while a straight conker clamp is placed to control back bleeding the uterine pedicle is divided and suture ligated you

the uterine side pedicle is secured with a Haney transfection stitch and the concur clamp removed to optimize exposure for the remainder of

the procedure you a straight Haney clamp is placed across the Cardinal ligament just medial to the uterine pedicle and at an angle almost parallel to

the long axis of the uterus the bladder is confirmed to be a safe distance away from the clamp and the Cardinal ligament is divided and suture ligated you continuous upward and contralateral traction on the uterus maximize his exposure to the operative field you once

the Cardinal ligaments have been divided the bladder is sharply dissected off of the proximal vagina the balloon of the Foley catheter is a useful landmark to delineate the bladder edge

the position and topography of the cervix is palpated between the thumb and forefinger an empty sponge stick is placed transvaginally and is used to locate

the anterior vaginal fornix an anterior Kol data I is created over the sponge stick this retrograde approach to the cervix is especially useful when

the cervix extends a significant distance into

the vagina and there is a desire to preserve maximum vaginal length or if the cul-de-sac of Douglas has been obliterated following the col pata me curved Haney clamps are placed at

the cervical vaginal junction and each pedicle is divided and secured with a suture ligature in a Haney trans fiction stitch each suture is held long and used to provide upward traction on

the vaginal tube you this process is repeated circumferentially around the cervical vaginal junction first clamping each pedicle then dividing and securing it with a suture ligature you the cervix is averted and the final two bytes are taken posteriorly and incorporate

the uterosacral ligament on either side you

the specimen is excised the posterior pedicle on each side secured with a horizontal mattress stitch that incorporates the proximal vaginal wall

the lower Cardinal ligament and the uterosacral ligament you this technique is simply fast and achieves satisfactory fixation of

the proximal vagina to the surrounding supporting ligaments you the remainder of the vaginal cuff is closed with figure-of-eight sutures

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