Supracervical amputation of the uterus

Surgical approaches to the pelvic organs

Two main routes are used for female reproductive organ surgeries: transperitoneal (laparotomy) and vaginal.

Vaginal approaches (Colpotomia) involve operating through the vaginal walls. There are anterior colpotomy (access via the anterior wall) and posterior colpotomy (via the posterior wall). Incisions of the anterior wall can be tongue-shaped, longitudinal midline, or combined (with an additional transverse incision at the bottom).

Transperitoneal approaches include lower midline laparotomy and the suprapubic transverse Pfannenstiel incision. Features of the Pfannenstiel approach:

• Skin: incised slightly arcuately within the suprapubic skin fold.
• Aponeurosis: the anterior wall of the rectus abdominis sheath is opened transversely. The upper flap is separated from the muscles sharply.
• Muscles: the rectus abdominis muscles are not cut, but bluntly separated along the linea alba and retracted laterally.
• Advantages: excellent cosmetic outcome and absence of postoperative hernias.

Technique of supracervical hysterectomy

The operation is performed via a lower midline laparotomy and consists of strictly standardized steps.

1. Exteriorization of the organ: the uterine fundus is grasped with Museux forceps and carefully brought out into the surgical wound.
2. Mobilization of ligaments: to ensure hemostasis, clamps are applied to the round ligament of the uterus (lig. teres uteri), the ovarian proper ligament (lig. ovarii proprium), and the fallopian tube. A second clamp is placed parallel to the uterine angle. The structures are transected between the clamps and ligated. Similar steps are performed on the opposite side.
3. Bladder mobilization: surgeons incise both layers of the broad ligament up to the uterine border and open the vesicouterine peritoneal fold (plica vesicouterina). The urinary bladder is pushed down from the uterine cervix partly bluntly and partly sharply, strictly avoiding injury to it.
4. Vessel management: the uterine vessels are clamped, transected, and ligated. At this stage, it is critically important not to include the ureter in the ligature.
5. Amputation: the uterine body is amputated above the level of uterosacral ligament origin. The incision is wedge-shaped — a small wedge is excised from the remaining cervix to make the edges easier to approximate.

Stump management and reperitonealization

Stump reperitonealization is a crucial step aimed at achieving definitive hemostasis and securely closing the wound surface.

• The edges of the cervical stump are treated with iodine and approximated with catgut sutures.
• The same sutures are used to pierce the edges of the anterior and posterior leaves of the broad ligament of the uterus.
• When tying the knots, all vascular bundles and ligament stumps are buried beneath the peritoneum.
• The edges of the vesical fold are sutured to the peritoneum of the posterior surface of the remaining uterine stump (forming the so-called "cap").
• The anterior abdominal wall wound is closed in layers to tightness.

Fallopian tube resection and defect closure

If tube resection is required during the procedure, surgeons mobilize its uterine (isthmic) end and mesosalpinx (mesosalpinx). Clamps are applied sequentially to the mesosalpinx for hemostasis, and then the tube is transected.

To reperitonealize the resected tube stump, a loop of the round ligament of the uterus (lig. teres uteri) is used and sutured to the uterine angle:

• Main option: the round ligament is sutured with a continuous catgut suture to the remnants of the tube mesosalpinx (leaves of the broad ligament), completing the suture line in a semi-purse-string fashion.
• In case of tissue deficiency: if the size of the remaining mesosalpinx is insufficient, the round ligament is sutured directly to the ovary, also completing the step with a semi-purse-string suture.

باختصار: إجابات عن أسئلة حول الموضوع

أسئلة من المحاضرات والامتحانات

مواضيع أخرى للمراجعة في نفس السياق

• التضاريس الطبقية لجدار البطن الأمامي للوصول بطريقة بَفاننشتیل (Pfannenstiel).
• خيارات الشقوق للوصول عبر المهبل (على شكل لسان، طولي، مركب).
• تضاريس الشرايين الرحمية وعلاقتها بالحالبين.
• تقنية وضع غرزة نصف الكيس أثناء تغطية ملحقات الرحم بالبريتون.

موضوعات أخرى من قسم «عمليات أعضاء الحوض الصغير والعجان»

تم إعداد المادة بواسطة أعضاء هيئة التدريس في WhiteCoat Pro وفقاً للمنهج الدراسي لكليات الطب. وهي ذات طابع تعليمي.