[hystero- + -ectomy]
Surgical removal of the uterus. Each year in the U.S., about 600,000 women undergo hysterectomies. Indications for the surgery include benign or malignant changes in the uterine wall or cavity and cervical abnormalities (including endometrial cancer, cervical cancer, severe dysfunctional bleeding, large or bleeding fibroid tumors (leiomyomas), prolapse of the uterus, intractable postpartum hemorrhage due to placenta accreta or uterine rupture, or severe endometriosis). The approach to excision may be either abdominal or vaginal. The abdominal approach is used most commonly to remove large tumors; when the ovaries and fallopian tubes also will be removed; and when there is need to examine adjacent pelvic structures, such as the regional lymph nodes. Vaginal hysterectomy is appropriate when uterine size is less than that in 12 week gestation; when no other abdominal pathology is suspected; and when surgical plans include cystocele, enterocele, or rectocele repair.
SYN: SEE: uterectomy
In preparation for abdominal hysterectomy, the patient is placed in the dorsal position. The table is ready to be tipped into the Trendelenburg position. As soon as the incision is made through the peritoneum, the table should be put into the Trendelenburg position. This procedure is the same for all abdominopelvic surgery, as the Trendelenburg position allows the abdominal organs to fall away from the pelvis so that they may be easily packed off and isolated from the surgical field with large pads or a large roll of packing.
Preoperative: In general, preparations for an abdominal hysterectomy are similar to protocols for any abdominopelvic surgery, e.g., abdominal skin preparation, insertion of an intravenous line and, depending on surgical protocol, an indwelling urinary catheter. Vaginal irrigation with antibacterial solution also may be ordered. All procedures are explained to the patient, who is provided with anticipatory guidance for the postoperative period. Misconceptions are clarified, informed consent is validated, and the signing of the operative permit is witnessed. The patient may be encouraged to discuss the personal meaning and implications of the procedure, such as permanent inability to bear children; emotional support is given. The gynecologist and nurses should make available opportunities for the patient to ask questions and receive information about sexual concerns and be provided with resources (or a way to access resources), or specialist referrals for further information as desired. Controlled trials that have studied large numbers of women have not shown, in aggregate, any adverse effect of hysterectomy on sexuality (good sexual function is retained or regained; however the nature and quality of sexual response may change) or women's perceptions of their femininity.
Postoperative: Initial status assessments include color; vital signs; airway patency and breath sounds; level of consciousness and discomfort; intravenous intake; and nasogastric and indwelling catheter drainage. During the first few hours, assessments usually are made over lengthening intervals, from every 10 to 15 min. during the first hour to every 30 min. to hourly. Intervals and assessment priorities may be altered on the basis of current findings, such as bleeding. Color; vital signs; airway patency and lung sounds; level of consciousness and discomfort; intake and output (including intravenous fluids, nasogastric and indwelling catheter drainage); and abdominal dressings (intact, amount and character of any drainage) are monitored. Additional later assessments include bowel sounds; lower extremity circulation (pedal pulses, leg pain); and wound status (redness, edema, ecchymosis, discharge, and approximation). The patient is encouraged to splint the incision, turn from side to side, use incentive spirometry, deep breathe and cough every 2 hr, and use incentive spirometry. Prescribed intravenous fluids and analgesics are administered. The woman is assisted in self-administering patient-controlled analgesia. Antithromboembolitic devices (pneumatic dressings or elastic stockings) are applied as needed. The patient is encouraged and assisted with early ambulation. The patient is encouraged to splint the incision, turn from side to side, deep breathe and cough every 2 hr, and use incentive spirometry.
If the patient's ovaries have been removed, the reasons for hormone therapy are explained to her. Effective coping strategies related to anticipated radiation and/or chemotherapy are targeted. Desired outcomes include evidence of incisional healing; absence of complications; return of normal GI and bladder function; and understanding of and compliance with the prescribed treatment regimen.
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