II Lecture Chapter 15 Short Answer/Discussion: Gynecological Abdominal Procedures pp 341

what should be done as warm, moist sponges are used to pack the bowel cephalad

count sponges as they are placed and have circulator record the number

describe the structures removed for a Wertheim procedure. what is the alternate name for the procedure

en bloc removal of the ovaries, fallopian tubes, uterus, and ligaments, upper third of the vagina, and associated lymph nodes radical hysterectomy

identify which procedure ligates the following ligaments first A. Uterosacral ligaments B. Round and ovarian ligaments (broad ligament)

Vaginal Hysterectomy

what are the advantages of the LAVH (laparoscopically assisted vaginal hysterectomy) approach

-allows potential abdominal hysterectomies to be converted to far less traumatic vaginal approaches shortening the patient's hospital stay considerably -provides visualization of the abdominal procedure

list three transverse incisions used for gynecological surgery. which incision provides the best cosmetic result and is 30 times stronger? what are the advantages of this incision?

1) transverse 2) vertical 3) oblique *transverse incisions provide the best cosmetic result and are nearly thirty times stronger after repair, are relatively more time consuming and hemorrhagic than vertical incisions and can compromise nerves, generally involve the division of muscles, and may limit access to the upper abdomen

list the structures that will be removed during a total pelvic exenteration (complete surgical removal of a body organ)

A pelvic exenteration removes reproductive organs, the bladder or rectum or both, and lymph nodes in the pelvis. Sometimes part of the colon and anus are also removed. The female reproductive organs removed are the ovaries, fallopian tubes, uterus, cervix and vagina.

what positioning tool is used to facilitate a low lithotomy position

Allen stirrups; arms are tucked patients hands are padded shoulder supports to keep patient from sliding when in steep trendelenburg position

what ligaments provide support for the ovaries? during an oophorectomy, which is ligated first?

infundibular/suspensory ligament and ovarian ligament the infundibular ligament forms the suspensory ligament. the suspensory ligament is divided and ligated first

why does the pelvic exenteration require two setups

one setup for the abdomen and a second setup for the perineum

what does an elevated serum CA-125 test indicate

ovarian cancer neoplastic ovarian tumor endometriosis

anticipation for a TAH dissection requires some modification. describe what you will pass

preferred hysterectomy clamps Heaney Clamps & Heaney-Ballantine clamps

where is the robotic cart with arms positioned for a robot-assisted hysterectomy

the circulator positions the robotic cart with the robot arms either along the side or between the legs of the patient without contaminating the sterile field

myomectomy is the excision of

the excision of uterine fibroids called myomas (has a higher rate of morbidity and bleeding than hysterectomy)

what structure(s) is (are) removed during a TAH (total abdominal hysterectomy)

the surgical removal of the uterus. commonly, it also involves the removal of the cervix, ovaries, fallopian tubes and other surrounding structures such as lymph nodes.

during dissection for the Wertheim procedure, what structures must be properly identified to prevent injury

the ureters, iliac artery, bladder surface, and nerves

why are the Jorgenson scissors and surrounding clamps considered contaminated

they may project into the vagina and should be isolated or removed from the field after use