Introduction to sub-total hysterectomy for sub-total hysterectomy

1. Uterine fibroids, functional uterine bleeding, adenomyoma, cervical examination is normal, and the patient asks for cervical preservation.

2. Those who need to remove the uterus for various reasons but have difficulty in removing the cervix. 1. continuous epidural block anesthesia.

2. General anesthesia with endotracheal intubation. 1. Incision Same as myomectomy. 2. Exploration To find out the size and mobility of the uterus and the cervix.

3. Cutting the round ligament Clamp the uterine horns on both sides and pull them outward toward the abdominal cavity. The round ligament is cut off by clamping at 1cm from the uterine horn, and the distal end is sutured.

4. Handling of accessories The ligament of the ovary and the tubal interstitium are cut off by clamping at the uterine horn, and the severed end is sutured with an "8" suture.

5. Expose the lower uterine segment and open the anterior lobe of the broad ligament and the vesicoureteral peritoneum along both sides of the uterus. Lift the vesicoureteral peritoneum and in the loose tissue space between the bladder fascia and the cervical fascia, separate the bladder downward to the isthmus of the uterus, and then cut the posterior lobe of the broad ligament along both sides of the uterus to the isthmus of the uterus.

6.Treatment of uterine blood vessels Cut off the uterine arteries, veins and paramedian tissues at the level of the isthmus of the uterus by clamping against the lateral wall of the uterus, and suture the stumps.

7. Removal of the uterine body Pull back the bladder to expose the isthmus of the uterus, make a circular incision at the isthmus, penetrate the mucous membrane layer of the cervical canal, and cut out the uterus. The cervical stump is sterilized and closed with absorbable suture in the form of an "8".

8. Reconstruction of the pelvic peritoneum Suture the pelvic peritoneum of the pelvic cavity, the bilateral adnexal severity, round ligament severity, cervical stump embedded in it.

9. Closure of the abdomen Layers of the abdominal wall are closed in layers. There are several reasons for removing the uterus, including: (1) severe chronic infection (pelvic infectious venereal disease)

(2) severe endometrial infection

(3) uterine fibroids

(4) fibroid tumors of the uterus, endometrial carcinoma

(5) cancer of the cervix, ovary

(6) severe uterine hemorrhage (rupture of the uterus, postpartum hemorrhage)

Hysterectomy is a common gynecological surgery, and the surgery can be divided into total hysterectomy, partial hysterectomy and extended hysterectomy. Partial hysterectomy removes only the upper part of the uterus, leaving the base of the uterus and cervix intact. A total hysterectomy removes the uterus along with the cervix. An extended hysterectomy removes the uterus, both fallopian tubes and ovaries, and the upper part of the vagina. The hysterectomy can be performed either abdominally or vaginally; the former is called a transabdominal hysterectomy and the latter is called a transvaginal hysterectomy.

Due to the structural characteristics of the female reproductive tract, there are several methods available to remove the diseased uterus. Traditionally, the uterus is removed either transabdominally or transvaginally. Laparoscopic total hysterectomy means that the ligaments, blood vessels, and vaginal wall around the uterus are severed laparoscopically, the uterus is removed from the vagina, and the vaginal severed ends are sutured again laparoscopically. There are several different types of laparoscopic hysterectomy in addition to total hysterectomy, including laparoscopic-assisted vaginal hysterectomy (LAVH), laparoscopic subtotal hysterectomy, and laparoscopic endofascial hysterectomy. Laparoscopic technology has brought medicine into the era of minimally invasive surgery, and this era of minimally invasive surgery can be boiled down to a few phrases: minimal injury, minimal inflammatory response and optimal incision healing, minimal tissue scarring and optimal therapeutic outcome. Laparoscopic hysterectomy began in 1989. With the development of various surgical instruments, this procedure is widely performed. Although LAVH is easy to perform because of relatively few laparoscopic maneuvers, the vaginal portion of LAVH is very difficult in difficult cases such as endometriosis and pelvic adhesions and other disorders that make the uterus not easy to pull down. In such patients, laparoscopic total hysterectomy, on the other hand, is relatively easy to perform because it is performed entirely laparoscopically. Compared with abdominal total hysterectomy and vaginal total hysterectomy, laparoscopic surgery offers a clearer view, and in patients with combined endometriosis and pelvic adhesions, laparoscopic hysterectomy becomes even more advantageous as it avoids both the difficulties of vaginal surgery and the trauma of open surgery, and expands the scope of minimally invasive surgery.

Along with laparoscopic total hysterectomy, laparoscopic surgical treatment of other diseases can be performed, such as resection of endometriosis foci, removal of ovarian tumors, vaginal severance suspension, laparoscopic repair of pelvic floor defects, and suspension of bladder neck pubic comb ligament. Laparoscopic lymph node dissection can also be performed to treat endometrial and cervical cancers.

Compared with open total hysterectomy, due to its small incision, it has fewer postoperative comorbidities, less need for postoperative analgesia, and a quicker return to normal work and life. Laparoscopic incision is small, which is more favorable to obese patients, with a clear vision at the time of operation, avoiding the problem of poor healing caused by large abdominal incisions. Laparoscopic, negative and open total hysterectomy, the first two of which are minimally invasive, are much faster than open total hysterectomy, and there is no difference in postoperative recovery between laparoscopic and negative procedures. Nonetheless, laparoscopic total hysterectomy still has advantages that are not comparable to negative hysterectomy, mainly the clear understanding of the pelvic cavity, a clear operative field, and the ability to deal with coexisting pelvic lesions at the same time. In complex cases, laparoscopic surgery is a much safer option than the negative procedure. Therefore, for simple total hysterectomy, either negative or laparoscopic surgery can be the preferred procedure. In contrast, laparoscopic total hysterectomy should be the procedure of choice for combined pelvic adhesions, endometriosis, and other pathologies that require hysterectomy. However, both laparoscopic and negative hysterectomy still have their limitations, that is, they can not complete the hysterectomy of a huge uterus or pelvic adhesions, and these patients should have a full estimate of the choice of laparotomy, or encounter difficulties during the operation, and then transferred to the abdomen.