Question

a 59 year old patient has been diagnosed with endometrial cancer and admitted for radical hysterectomy with bilateral lymphadenectomy. The procedure will be performed through a midline incision and expected to take 3 hours.

1. what anatomical structures will be sent for pathology?

2.what specific patient care is required between the time the patient is transported to the OR and the patient is anesthesized?

3. which abdominal self retaining retrators might be used in this procedure?

4. what size and type of suture might be used on the uterine ligaments?

5. how will the lymph nodes be managed on the backtable? how will they be identified and labelled?

6. will tghe retroperitoneum be entered during this procedure?

7. what instrument sets will be required for this procedure?

8. will a vaginal prep be necessary for the procedure? please provide a rationale for your answer

Answer 1

Question 1

Conization specimen will be sent for pathology for histologic evaluation. The conization of the cervix is mainly the excision of a large cone-shaped piece or a cylindrical wedge from the cervix by using scalpel. A conization specimen by using ba ocular micrometer to establish the depth of stomal invasion.

Question 2

The patient preparation by giving proper care is needed between the patient is transported to the Operating room and the patient is anesthesized.

• The health care provider should explain the procedure first to the patient.
• The health care provider must mention the possible complications may occur after surgery.
• The report of blood & urine test of the patient should be evaluated.
• The pubic hair & the hair of the abdominal area will be shaved clearly.
• The intravenous ( IV) line should be placed in a vein of the arm to deliver medications & fluids according to need during surgery.

Question 3

Balfour, bookwalter, the self retaining retractors might be used in this procedure.

Question 4

2-0 or 3-0 silk is for ligation, the Z sutures with the 3-0 absorbable suture.These size & types of sutures might be used.

Question 5

After removing the lymph nodes ay first it is needed to observe about the number of lymph nodes removed & the particular number of lymph nodes which have cancer cells.

They will be identified &labbled on the basis of they are cancerous or not.

Here

• The positive lymph node is having cancer cells.
• The negative lymph node is not having any cancer cells.
• It may also be reported & labelled if the Cancer has grown through outer covering means the capsule of the lymph nodes.
• & If the cancer ca present by the level of cancer the label should be done.

Question 6

Yes, the retroperitoneum will be entered during this procedure. Because the gynecological surgery is essentially the surgery in the retroperitoneum, it is important as well as necessary for the surgeon to enter & explore the retroperitoneal cavity.

Question 7

The instrument sets which are needed for abdominal radical hysterectomy with bilateral lymphadenectomy.

2 Mayo Diss Sciss Straight 6 ¾
1 Mayo Diss Sciss Curved 5 1/2"
2 Mayo Diss Scissor Curved 6 3/4"
12 Halsted Mosquito Forcep Curved 5"
6 Kelly Forcep Straight 5 1/2"
18 Kelly Forcep Curved 5 1/2"
18 Roch-pean Fcp Cvd 6 1/4"
6 Roch-pean Fcp Cvd 7 1/4"
12 Roch-osch Fcps Straight 1x2 6 1/4"
2 Serrated Dressing Forcps 5 1/2"
1 Serrated Dressing Forceps 8"
2 Tissue Forcep 1x2 5 1/2"
1 Tissue Forcep 1x2 8"
2 Crile Murray Nh Serr 6" Tcsg
2 Mayo Hegar Nh 7" Tcsg
2 Mayo Hegar Nh 8" Tcsg
1 Metz Lahey Del Crv Scissor 5 ¾
1 Sut Wire Cut Scis Ser Ang 43/4
1 Dir&tongue Tie (probe) 6"
1 Ochsner Tr 20fr F 16fr Cath
1 Poole Suct Tb Slip On Straight 30fr
4 Babcock Forceps 5.5"
4 Babcock Forcep 8"
12 Allis Tissue Forcep 3x4 6"
4 Allis Tissue Fcp 5x6 7 1/2"
1 Us Army Retractor Set/2 D/e 8 1/4"
1 Parker De Retr 5/8x5 Set/2
2 Kelly Retractor 9.5" 2"x2.5"
2 Richardson W/sklrgrp Handle Med
1 Richardson-eastman Retr Set/2
1 Deaver Skl Grip Handle #0 1" X10"
1 Deaver Skl Grip Handle #1 1" X12"
1 Deaver Skl Grip Handle #2 1"x 13"
1 Deaver Skl Grip Handle #3 1-1/2 X12
1 Deaver Skl Grip Handlel #4 2 X 12
1 Deaver Skl Gr Hdl #5 3 X 12
2 Zalkind Ribbon Retr 1 1/2x13"
2 Volkman Retr Usa Sharp 6pr 81/2
2 Volkman Retr Usa Shrp 3pr 81/3
1 Balfour Abdomen Retr Fenstr Bl7"
1 Metzenbaum Scissors Curved 7
12 Backhaus Towel Clamp 5 1/4"
8 Foerster Sponge Serr Str 91/2"
2 Deaver #5 3x12
1 Tissue Fcp 1x2 8"
6 Allis Tiss Fcp 5x6 7 1/2"
1 Tissue Fcp 1x2 12"
6 Roch-pean Fcp Curvd 6 1/4"
6 Roch Ochsner Fcp Straight 1x2 7 ¼
2 Schroeder (braun) Ten Forcep 91/2
2 Schroeder Vulsllm Fcp Straight 9.5"
4 Heaney Single Tooth Heavy 8 1/4"
1 Mayo Dissection Scissor Cvd 9"
1 Kelly-adson Sciss Curvd Sm 6 ¼
1 HYSTEREC CLAMP ATRAU STR 9 1/2"
1 HYSTEREC CLAMP ATRAU SL CV 91/2
1 HYSTEREC CLAMP ATRAU 3/4 CRV
1 Scalpel Handle no. 3
1 Scalpel Handle no. 4

Question 8

Yes , this preparation is necessary for this procedure.

Rationale:- It is recommended that the cholrhexidine gluconate surgical or topical anticeptic solution is needed on this bacterial environment of the during abdominal radical hysterectomy & basically compare that to the effect of iodine based preparation on the same.

It is actually needed to prevent the post operative infection, because mostly 40% of patient undergoing a hysterectomy can develop a post- operative infection.

So this type preparation , the initiation of antibiotic prophylaxis is only for appropriate surgical procedure for the prevention of surgical site infection.

( Here I didn't use the word of "female genital organ"because the using of this type of word is prohibited here & it didn't allow me to submit the answer , that's why.)