Obstetrics And Gynecology / / August 12, 2017
(method of operation)
Vaginal operations produce a roll of the vaginal walls, cervix and uterine body, the insolvency of the pelvic floor, the vagina in benign tumors or cysts of retention.
operation Objectives: 1) removal of the uterus without appendages with vaginal plasty and pelvic floor;2) removal of benign tumors or cysts.
Tools: hemostatic clips straight - 10 Pean clamps - 5 short clips Kocher -5, curved forceps - 3, needle holders - 2, scalpels - 2, scissors - 2 (one long Cooper), pincers - 4(2 anatomical, surgical 2), fenestrated forceps, hooks ranorasshiryayuschie farabeuf - 2, speculum, short lift Duaena forceps bidentate -2, metallic catheter linen hoe - 8. Cutting surgical needles №3, 4, 5, 6.
Suture: catgut №4, 5, 6.
sterile material: average napkins - 2 pack, small towels - 5 packs.ID
Regulation patient - lithotomy.The patient is placed on a shortened operating table: the bottom part of the table is lowered.The legs bend at the knees a
surgeon performs the operation while seated.The operating table is set to the right and slightly behind the surgeon.Position assistants indicated.
When vaginal hysterectomy uterine surgery is divided into 2 stages.
first stage - removal of the uterus through the vagina with the fixation of the bladder.Sister takes the speculum and the cotton swab with alcohol for re-processing of the vagina, then bidentate tongs, which fixes the cervix.Consistently serves scalpel for excision of the flap of the vaginal wall and long scissors Cooper for otseparovki bladder.After separation bubble again give the surgeon's scalpel and scissors for opening the vaginal vault, then 6 long powerful hemostatic clips imposed on each side on the ligament, vascular bundles and appendages that cut off with scissors and consistently sheathe separate catgut sutures (catgut №3, 4).At the ends left by a guide filaments are locking clips.
After removal of the uterus sister delivers continuous catgut thread №3, 4, 20 cm long to fix the bladder.Then 2 continuous catgut suture №4 20 cm at the stump and the front wall of the vagina.The first phase of the operation is considered complete.Participants treated with arms operations, sister is changing tools;surgical site is treated with sterile wipes.
second stage of the operation - suturing the vagina.Sister gives a short clip Kocher, scalpel, scissors then that flap otseparovyvayut vagina and perineum;hemostats and then separate catgut thread for blouses bleeding vessels and continuous catgut thread №4 20 cm long at the back wall of the vagina, 3 separate catgut thread №6 on a large cutting needle in the muscles of the pelvic floor.Separate the threads catgut (catgut №2) - on the fiber and continuous filament (catgut number 2) - on the skin of the perineum.cutting line treated with iodine.Sister imposes aseptic U-shaped bandage.
Training, tools and position the patient with other vaginal operations (vaginal and perineal trauma, removal of cysts, benign tumors, vaginal and perineal plastic) are the same as with vaginal hysterectomy with plastic perineal and pelvic floor.