What Is a Subtotal Hysterectomy?

Subtotal hysterectomy can be used for the surgical treatment of uterine fibroids. Subtotal hysterectomy, also known as partial hysterectomy or vaginal hysterectomy, surgically removes the uterine body and preserves the cervix.

Subtotal hysterectomy

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Subtotal hysterectomy can be used for the surgical treatment of uterine fibroids. Subtotal hysterectomy, also known as partial hysterectomy or vaginal hysterectomy, surgically removes the uterine body and preserves the cervix.

Subtotal hysterectomy

Partial hysterectomy; supravaginal hysterectomy; subtotal hysterectomy; subtotal abdominal hysterectomy

Obstetrics and Gynecology / Gynecological Surgery / Abdominal Surgery / Benign Disease Surgery / Uterine Fibroid Surgery / Hysterectomy

68.3902

Subtotal hysterectomy is suitable for:

1. Uterine fibroids or other benign uterine diseases, such as functional uterine bleeding, adenomyoma (disease), etc., young women who need to remove the uterus and have a normal cervix can retain the cervix.

2. There is no serious cervical disease, and the general condition of the patient is poor, or there are serious systemic complications, can not support more complicated hysterectomy surgery, or have extensive adhesions, who have difficulty in performing full uterine surgery.

1. There are serious lesions in the cervix, such as atypical hyperplasia, severe erosion, or suspicious cervical smear cytology, it is not advisable to keep the cervix.

2. Malignant uterine fibroids.

3. Patients with endometrial malignancy.

4. Patients with attached malignant lesions.

5. Acute pelvic inflammation.

1. Preparation before abdominal surgery in general gynecology.

2. Cervical smear for cancer cells.

3. Menstrual disorders and patients under the age of 50 should undergo diagnostic curettage before surgery to fully understand the uterine condition, with the exception of endometrial lesions, to determine ovarian retention.

Epidural anesthesia, general anesthesia or subarachnoid anesthesia are generally used. The supine position was taken in the surgical position.

2. Explore the pelvic cavity

Understand the uterus, appendages, and lesions, and determine the size, location, and adhesion of the tumor, as well as the relationship with surrounding organs. When malignant tumors are suspected, the diaphragm, liver, spleen, stomach, kidney, intestine, greater omentum, and lymph node metastasis should also be explored. After the exploration, the intestinal canal was opened with a large saline gauze pad, and a retractor was placed to fully expose the surgical field. If there is adhesion, it should be sharp or blunt.

3. Lift the uterus

With two toothed vascular forceps, the two sides of the uterus are clamped along the uterine horn to the ovarian ligament for traction. There are also operations in which the uterus is held out of the abdominal cavity, which can be performed according to the size of the uterus and individual operating habits. Generally, if the uterus is not large, it is convenient to operate in the abdominal cavity, and it also reduces the chance of contamination of the abdominal cavity.

4. Handling round ligaments

Lift the round ligament with tissue forceps. At the distance of 3cm from the uterine attachment point, use the curved blood vessel forceps to clamp and cut off. Suture and ligate the distal end with 7-gauge silk thread or 1-0 chrome bowel thread.

5. Handling attachments

Depending on the condition and age of the patient, and whether the ovaries are normal, the decision to leave the ovaries is made. If the ovaries are not retained, the uterus, fallopian tubes, and ovaries are pulled upwards and laterally. The surgeon lifts the broad ligament forward with fingers or vascular forceps, avoiding the blood vessels, and uses 3 thick and curved vascular forceps from the outside to the inside. Clamp the pelvic funnel ligaments side by side. To prevent slippage, the clamps slightly exceed the blood vessels, and pay attention to the oviduct side of the fallopian tube when clamping, so as not to cause the short end of the blood vessels to slip or accidentally damage the ureter. Check that there is no other tissue after clamping. Cut the pelvic funnel ligament between the 2nd and 3rd pliers and use the 10th and 7th silk or nylon threads to pass through the suture. The opposite side is treated in the same way. If the ovary is retained, the mesentery of the fallopian tube is clamped with segmented forceps of the curved blood vessel forceps, and the 7th suture is cut. The ovarian ligament was clamped with thick and curved blood vessel forceps, cut off, and the 10th silk thread was ligated through the suture. When retaining the ovary and the fallopian tube, clamp the fallopian tube isthmus and ovarian ligament with thick and middle curved forceps, cut off, and use the 10 and 7 silk threads to pass through the suture.

6. Cut the bladder and fold the peritoneum, and push the bladder apart.

At the end of the uterine lateral ligament, between the two leaves of the broad ligament, insert blunt scissors, and separate and cut the anterior leaflet of the broad ligament and the peritoneum of the bladder to bend back along the edge of the uterus. You can also use toothless forceps to lift the loose free part in the center of the bladder peritoneum, and cut it open, and cut it to the sides of the bilateral ligament ends. Lift the edge of the bladder peritoneum with the forceps of the bladder, and use your fingers or a knife handle to blunt the bladder fascia and cervical fascia downward and on both sides to peel open the bladder. The uterine mouth is slightly lower, and the side reaches 1cm next to the cervix. When cutting the bladder and peritoneum, the depth of the bladder should be moderate, too deep to bleed easily, and not easy to peel off. Too shallow is easy to peel off. If the thickness of the incision is appropriate, the layers are clear, and the bladder can be pushed down smoothly and rarely bleed. When it is firmly connected to the cervix, it can be cut with scissors. If bleeding, you can use filament ligation or electrocoagulation to stop bleeding. After separation, fix the free edge of the bladder and peritoneum to the lower end of the incision to better expose the surgical field.

7. Isolate and cut the posterior leaf of the broad ligament

The assistant pulls the uterus forward, close to the uterus after cutting the broad ligament, and reaches the vicinity of the sacral ligament of the uterus. Pushing loosely the loose tissue in the wide ligament can expose the uterine arteries and veins. This is a non-vascular area, where the tissue is loose and easy to separate. If there are small blood vessels, they can be ligated.

8. Handling uterine blood vessels

After the front and back of the broad ligament were cut, the uterine arteries and veins were clearly exposed, and the blood vessels were beating. The blood vessels were also pulsed by hand, which was not easy for a few patients. Lift the uterus up and to one side, and use three thick, medium-curved vascular forceps at the level of the uterine isthmus, perpendicular to the side edge of the uterus, and clamp side by side. The bladder should be pushed open again before clamping. Uterine arterial clamps that are too high will increase the difficulty of surgery, while too low clamps are prone to encounter too many branches and cause bleeding. The tip of the forceps should be close to the uterus to prevent leakage of blood vessels. Here the ureter is closer to the uterus, so the forceps should not be pushed out to avoid damage to the ureter and bladder. After the jaws are accurate, cut between the upper and middle pliers, and the incision on the jaw end is slightly extended to facilitate stitching. The broken ends are each stitched through 10 silk threads and 7 silk threads. The opposite side is treated in the same way.

9. Removal of the uterus

How much of the uterus is removed depends on the specific situation. If young patients need to maintain menstrual cramps, the range of resection may be above the uterine mouth (the position of the uterine fibroids is low, except for those where surgery is not possible). Generally, the uterus can be removed with a flat inner mouth. Lift the uterus with your left hand, exposing the incision site, and place a wet gauze pad around to prevent cervical secretions from contaminating the surgical field. Tilt the blade for wedge resection, and the assistant lifts the stump of the cervix with tissue forceps. If the uterine blood vessels are completely sutured, the stump of the cervix will be white. If there is active bleeding, the stump should be sutured to stop bleeding. After the stump of the cervix is sterilized with 2.5% iodine and 75% ethanol, use a cervical needle to wear a No. 1 chrome bowel or nylon. Threads do 8-word or intermittent stitching.

10. Fixed round ligament

Some scholars are used to suturing the ligament stump on the stump of the cervix to prevent the cervix from sagging.

11. Suturing the pelvic peritoneum to clean the stump of the cervical stump. After the hemostasis is stopped, the pelvic peritoneum is continuously sutured with 4-0 silk sutures. Starting from the stump of the pelvic funnel ligament on one side, the peritoneum is lifted up and sutured continuously to the contralateral pelvic funnel ligament. Broken ends. When sutured, the broken ends are turned into the peritoneum to make the pelvic cavity peritoneal and form a smooth pelvic surface.

12. Suture the abdominal wall

See abdominal wall incision and suture.

After subtotal hysterectomy, do the following:

1. Same as general gynecological abdominal surgery.

2. Use antibiotics to prevent infection.

3. Regular women's disease surveys.