Hysterectomy - Revision history

Ckurian at 21:32, 1 April 2023

2023-04-01T21:32:01Z

← Older revision		Revision as of 14:32, 1 April 2023
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	}}		}}
	A '''hysterectomy''' is performed for a variety of indications, including uterine cancer, postpartum hemorrhage, fibroids, abnormal uterine bleeding, and endometriosis. It is most commonly performed laparoscopically, and is increasingly an outpatient procedure.<ref>{{Cite journal\|last=Morgan\|first=Daniel M.\|last2=Kamdar\|first2=Neil S.\|last3=Swenson\|first3=Carolyn W.\|last4=Kobernik\|first4=Emily K.\|last5=Sammarco\|first5=Anne G.\|last6=Nallamothu\|first6=Brahmajee\|date=2018-04\|title=Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women\|url=http://dx.doi.org/10.1016/j.ajog.2017.12.218\|journal=American Journal of Obstetrics and Gynecology\|volume=218\|issue=4\|pages=425.e1–425.e18\|doi=10.1016/j.ajog.2017.12.218\|issn=0002-9378}}</ref> It is the second-most common gynecological surgical procedure after Cesarean section in the United States<ref>{{Cite web\|title=Plotting the downward trend in traditional hysterectomy\|url=https://ihpi.umich.edu/news/plotting-downward-trend-traditional-hysterectomy\|access-date=2021-03-30\|website=ihpi.umich.edu\|language=en}}</ref>, and it is frequently performed alongside other procedures including bilateral salpingo-oophrectomy and pelvic/paraaortic lymph node dissection.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>		A '''hysterectomy''' is performed for a variety of indications, including uterine cancer, postpartum hemorrhage, fibroids, abnormal uterine bleeding, and endometriosis. It is most commonly performed laparoscopically, and is increasingly an outpatient procedure.<ref>{{Cite journal\|last=Morgan\|first=Daniel M.\|last2=Kamdar\|first2=Neil S.\|last3=Swenson\|first3=Carolyn W.\|last4=Kobernik\|first4=Emily K.\|last5=Sammarco\|first5=Anne G.\|last6=Nallamothu\|first6=Brahmajee\|date=2018-04\|title=Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women\|url=http://dx.doi.org/10.1016/j.ajog.2017.12.218\|journal=American Journal of Obstetrics and Gynecology\|volume=218\|issue=4\|pages=425.e1–425.e18\|doi=10.1016/j.ajog.2017.12.218\|issn=0002-9378}}</ref> It is the second-most common gynecological surgical procedure after Cesarean section in the United States<ref>{{Cite web\|title=Plotting the downward trend in traditional hysterectomy\|url=https://ihpi.umich.edu/news/plotting-downward-trend-traditional-hysterectomy\|access-date=2021-03-30\|website=ihpi.umich.edu\|language=en}}</ref>, and it is frequently performed alongside other procedures including bilateral salpingo-oophrectomy and pelvic/paraaortic lymph node dissection.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>

			* Surgical procedure: The selection for surgical approach requires consideration of the patient’s age, medical history, history of prior pelvic surgery, or presence/possibility of adhesions, endometriosis, uterine size and presence of uterine prolapse. The advantage of the laparoscopic approach includes shorter recovery time, quicker return of bowel function, less pain, less bleeding and adhesion formation, as well as lower wound complication rate. THe most common procedure is the laparoscopically assisted vaginal hysterectomy (LAVH) which is begun by laparoscopy with a combination of steps performed vaginally.

	== Preoperative management ==		== Preoperative management ==
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	\|Cardiovascular		\|Cardiovascular
	\|		\|
			* patients with advanced cardiac disease may not tolerate physiologic changes from pneumoperitoneum including higher HR, MAP, SVR, PVR and decreased venous return, preload, and CO.
	\|-		\|-
	\|Pulmonary		\|Pulmonary
	\|Many gynecological tumors are associated with cigarette smoking, assess for preexisting lung disease		\|Many gynecological tumors are associated with cigarette smoking, assess for preexisting lung disease.

			* Assess for respiratory disease, diaphragmatic hernia which increase the risk of respiratory compromise from abdominal insufflation.
	\|-		\|-
	\|Gastrointestinal		\|Gastrointestinal
	\|		\|
			* High BMI can complicate Trendelenburg positioning through decreasing diaphragmatic excursion when combined with insufflation.
	\|-		\|-
	\|Hematologic		\|Hematologic
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	\|Renal		\|Renal
	\|		\|
			* Evaluate for volume status as abdominal insufflation decreases preload
	\|-		\|-
	\|Endocrine		\|Endocrine
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	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===

	* ~~Midazolam~~		** The patient should be counseled including limiting NPO duration, alcohol/smoking cessation, review of nutritional status, post pain management options, recovery plan, and possibility of urinary drain post.
	* ~~Consider scopolamine~~ patch in ~~young women at~~ high risk for ~~PONV~~		*** Multimodal analgesia: Tylenol 650-1000 mg, celecoxib 200-400 mg, gabapentin 300-600 mg for post-op analgesia.
			*** Scopolamine patch for PONV prophylaxis in high risk patients
			*** IV midazolam for anxiolysis

	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
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	* 5-lead EKG		* 5-lead EKG
	* Urinary catheter		* Urinary catheter
			*EEG if utilizing a TIVA
	* 1-2 peripheral IVs (16-18 gauge)		* 1-2 peripheral IVs (16-18 gauge)
	* In hemorrhaging patients, consider arterial line and central access		* In hemorrhaging patients, consider arterial line and central access
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	* Standard induction		* Standard induction
	* In unstable patients including hemorrhaging patients, consider etomidate (BP control) and rapid sequence intubation (RSI)		* In unstable patients including hemorrhaging patients, consider etomidate (BP control) and rapid sequence intubation (RSI)
			*RSI is usually indicated for patients with an ectopic pregnancy
			*OG tube decompression prop to laparoscopic trocar insertion

	=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===

	* Dorsal lithotomy position, arms tucked		* Dorsal lithotomy position, arms tucked
			**Sciatic and femoral nerve injuries may occur in lithotomy position. Check to minimize hip abduction and external rotation. Carefully pad and secure the knees and heels
			**Watch hands and fingers carefully when arms are tucked at patient’s side.
	* Deep Trendelenburg position for laparoscopic approach		* Deep Trendelenburg position for laparoscopic approach

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	** GI: gastric content regurgitation		** GI: gastric content regurgitation
	** Cardiac: decreased cardiac output (decreased venous return) and bradycardia from pressure-induced vagal stimulation		** Cardiac: decreased cardiac output (decreased venous return) and bradycardia from pressure-induced vagal stimulation
			**Hematologic: Blood loss is usually minimal though could be significant during some procedures. Discuss with surgeon ahead of time.
			**Pain: Consider a ketamine infusion for chronic pain patients

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

	* PONV prophylaxis, especially in young women at higher risk		* PONV prophylaxis, especially in young women at higher risk.
			*Post-op pain control plan if surgical approach was converted to laparotomy.

	== Postoperative management ==		== Postoperative management ==
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	* Occasionally, same-day discharge		* Occasionally, same-day discharge

	=== Pain management~~<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->~~ ===		=== Pain management ===

	* ~~NSAIDs~~, ~~acetaminophen for mild pain~~		** Epidural, TAP block/catheters, Rectus sheath block/catheters should be considered if patients surgery was converted to an open approach
	* ~~Opioids for breakthrough pain.~~ Consider PCA ~~for open cases~~		** Consider a PCA if the patient had a larger incision than anticipated
	* ~~Consider TAP block for open cases with large abdominal incision~~		** Multimodal analgesia as discussed above

	=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===		=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
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	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
	<references />		<references />

			* Nelson G, Altman AD, Nick A, et al: Guidelines for pre- and intra-operative care in gynecologic/ oncology surgery: enhanced recovery after surgery (ERAS) Society recommendations-Part I. ''Gynecol Oncol 2016''; 140(2):313-22.

			* Gerges FJ, Kanazi GE, Jabbour-Khoury SI: Anesthesia for laparoscopy: a review. ''J Clinic Anesth 2006''; 18(1): 67-78.

	[[Category:Obstetric and gynecologic surgery]]		[[Category:Obstetric and gynecologic surgery]]

Chris.Rishel at 07:35, 5 April 2022

2022-04-05T07:35:49Z

← Older revision		Revision as of 00:35, 5 April 2022
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	{{Infobox surgical case reference		{{Infobox surgical case reference
	\| anesthesia_type = General		\| anesthesia_type = General
	\| airway = ~~Endotracheal tube~~		\| airway = ETT
	\| lines_access = Peripheral IV		\| lines_access = Peripheral IV
	\| monitors = Standard ~~ASA~~		\| monitors = Standard
	5-lead ~~EKG~~		5-lead ECG
	\| considerations_preoperative = Type and cross patients at risk for hemorrhage		\| considerations_preoperative = Type and cross patients at risk for hemorrhage
	\| considerations_intraoperative =		\| considerations_intraoperative =

Chris.Rishel: Text replacement - "|Respiratory" to "|Pulmonary"

2022-02-22T05:47:24Z

Text replacement - "|Respiratory" to "|Pulmonary"

← Older revision		Revision as of 22:47, 21 February 2022
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	\|		\|
	\|-		\|-
	\|~~Respiratory~~		\|Pulmonary
	\|Many gynecological tumors are associated with cigarette smoking, assess for preexisting lung disease		\|Many gynecological tumors are associated with cigarette smoking, assess for preexisting lung disease
	\|-		\|-

Chris.Rishel at 21:05, 21 February 2022

2022-02-21T21:05:02Z

← Older revision		Revision as of 14:05, 21 February 2022
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	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
			<references />
			[[Category:Obstetric and gynecologic surgery]]

Sapna.Desai at 15:38, 1 December 2021

2021-12-01T15:38:36Z

← Older revision		Revision as of 08:38, 1 December 2021
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	* NSAIDs, acetaminophen for mild pain		* NSAIDs, acetaminophen for mild pain
	* Opioids for breakthrough pain. Consider PCA for open cases		* Opioids for breakthrough pain. Consider PCA for open cases
			* Consider TAP block for open cases with large abdominal incision

	=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===		=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===

Nkamdar at 15:51, 12 July 2021

2021-07-12T15:51:25Z

← Older revision		Revision as of 08:51, 12 July 2021
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	* Dorsal lithotomy position, arms tucked		* Dorsal lithotomy position, arms tucked
	* ~~Often~~ Trendelenburg position for laparoscopic approach		* Deep Trendelenburg position for laparoscopic approach

	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
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	!Open		!Open
	!Laparoscopic		!Laparoscopic
			!Robotic
			Laparoscopic
	\|-		\|-
	\|Unique considerations		\|Unique considerations
			\|
	\|		\|
	\|		\|
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	\|Dorsal lithotomy		\|Dorsal lithotomy

			Steep Trendelenburg
			\|Dorsal lithotomy
	Steep Trendelenburg		Steep Trendelenburg
	\|-		\|-
	\|Surgical time		\|Surgical time
			\|
	\|		\|
	\|		\|
	\|-		\|-
	\|EBL		\|EBL
			\|
	\|		\|
	\|		\|
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	Poss. same day discharge		Poss. same day discharge
			\|
	\|-		\|-
	\|Pain management		\|Pain management
	\|Regional		\|Regional
	\|Oral narcotics vs. PCA		\|Oral narcotics vs. PCA
			\|
	\|-		\|-
	\|Potential complications		\|Potential complications
			\|
	\|		\|
	\|		\|

Nkamdar: Physiological changes on laparoscopic approach.

2021-07-10T19:48:41Z

Physiological changes on laparoscopic approach.

← Older revision		Revision as of 12:48, 10 July 2021
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	\| considerations_postoperative = PONV		\| considerations_postoperative = PONV
	}}		}}
	A '''hysterectomy''' is performed for a variety of indications, including uterine cancer, postpartum hemorrhage, fibroids, abnormal uterine bleeding, and endometriosis. It is most commonly performed laparoscopically, and is increasingly an outpatient procedure.<ref>{{Cite journal\|last=Morgan\|first=Daniel M.\|last2=Kamdar\|first2=Neil S.\|last3=Swenson\|first3=Carolyn W.\|last4=Kobernik\|first4=Emily K.\|last5=Sammarco\|first5=Anne G.\|last6=Nallamothu\|first6=Brahmajee\|date=2018-04\|title=Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women\|url=http://dx.doi.org/10.1016/j.ajog.2017.12.218\|journal=American Journal of Obstetrics and Gynecology\|volume=218\|issue=4\|pages=425.e1–425.e18\|doi=10.1016/j.ajog.2017.12.218\|issn=0002-9378}}</ref> It is the second-most common gynecological surgical procedure after ~~cesarean~~ section in the United States<ref>{{Cite web\|title=Plotting the downward trend in traditional hysterectomy\|url=https://ihpi.umich.edu/news/plotting-downward-trend-traditional-hysterectomy\|access-date=2021-03-30\|website=ihpi.umich.edu\|language=en}}</ref>, and it is frequently performed alongside other procedures including bilateral salpingo-oophrectomy and pelvic/paraaortic lymph node dissection.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>		A '''hysterectomy''' is performed for a variety of indications, including uterine cancer, postpartum hemorrhage, fibroids, abnormal uterine bleeding, and endometriosis. It is most commonly performed laparoscopically, and is increasingly an outpatient procedure.<ref>{{Cite journal\|last=Morgan\|first=Daniel M.\|last2=Kamdar\|first2=Neil S.\|last3=Swenson\|first3=Carolyn W.\|last4=Kobernik\|first4=Emily K.\|last5=Sammarco\|first5=Anne G.\|last6=Nallamothu\|first6=Brahmajee\|date=2018-04\|title=Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women\|url=http://dx.doi.org/10.1016/j.ajog.2017.12.218\|journal=American Journal of Obstetrics and Gynecology\|volume=218\|issue=4\|pages=425.e1–425.e18\|doi=10.1016/j.ajog.2017.12.218\|issn=0002-9378}}</ref> It is the second-most common gynecological surgical procedure after Cesarean section in the United States<ref>{{Cite web\|title=Plotting the downward trend in traditional hysterectomy\|url=https://ihpi.umich.edu/news/plotting-downward-trend-traditional-hysterectomy\|access-date=2021-03-30\|website=ihpi.umich.edu\|language=en}}</ref>, and it is frequently performed alongside other procedures including bilateral salpingo-oophrectomy and pelvic/paraaortic lymph node dissection.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>

	== Preoperative management ==		== Preoperative management ==
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	* Dorsal lithotomy position, arms tucked		* Dorsal lithotomy position, arms tucked
			* Often Trendelenburg position for laparoscopic approach

	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
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	** Resp: atelectasis, decrease FRC, increase PIPs, and increase CO2. May also cause endobronchial intubation		** Resp: atelectasis, decrease FRC, increase PIPs, and increase CO2. May also cause endobronchial intubation
	** GI: gastric content regurgitation		** GI: gastric content regurgitation
	** Cardiac: decreased cardiac output		** Cardiac: decreased cardiac output (decreased venous return) and bradycardia from pressure-induced vagal stimulation

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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	* PACU		* PACU
			* Occasionally, same-day discharge

	=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===		=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
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	\|+		\|+
	!		!
	!~~Variant 1~~		!Open
	!~~Variant 2~~		!Laparoscopic
	\|-		\|-
	\|Unique considerations		\|Unique considerations
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	\|Position		\|Position
	\|		\|
	\|		\|Dorsal lithotomy

			Steep Trendelenburg
	\|-		\|-
	\|Surgical time		\|Surgical time
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	\|Postoperative disposition		\|Postoperative disposition
	\|		\|
	\|		\|PACU

			Poss. same day discharge
	\|-		\|-
	\|Pain management		\|Pain management
	\|		\|Regional
	\|		\|Oral narcotics vs. PCA
	\|-		\|-
	\|Potential complications		\|Potential complications

Chris.Rishel at 16:57, 12 May 2021

2021-05-12T16:57:32Z

← Older revision		Revision as of 09:57, 12 May 2021
Line 1:		Line 1:
	A '''hysterectomy''' is performed for a variety of indications, including uterine cancer, postpartum hemorrhage, fibroids, abnormal uterine bleeding, and endometriosis. It is most commonly performed laparoscopically, and is increasingly an outpatient procedure.<ref>{{Cite journal\|last=Morgan\|first=Daniel M.\|last2=Kamdar\|first2=Neil S.\|last3=Swenson\|first3=Carolyn W.\|last4=Kobernik\|first4=Emily K.\|last5=Sammarco\|first5=Anne G.\|last6=Nallamothu\|first6=Brahmajee\|date=2018-04\|title=Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women\|url=http://dx.doi.org/10.1016/j.ajog.2017.12.218\|journal=American Journal of Obstetrics and Gynecology\|volume=218\|issue=4\|pages=425.e1–425.e18\|doi=10.1016/j.ajog.2017.12.218\|issn=0002-9378}}</ref> It is the second-most common gynecological surgical procedure after cesarean section in the United States<ref>{{Cite web\|title=Plotting the downward trend in traditional hysterectomy\|url=https://ihpi.umich.edu/news/plotting-downward-trend-traditional-hysterectomy\|access-date=2021-03-30\|website=ihpi.umich.edu\|language=en}}</ref>, and it is frequently performed alongside other procedures including bilateral salpingo-oophrectomy and pelvic/paraaortic lymph node dissection.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>

	{{Infobox surgical case reference		{{Infobox surgical case reference
	\| anesthesia_type = General		\| anesthesia_type = General
Line 6:		Line 4:
	\| lines_access = Peripheral IV		\| lines_access = Peripheral IV
	\| monitors = Standard ASA		\| monitors = Standard ASA
	5 lead EKG		5-lead EKG
	\| considerations_preoperative = Type and cross patients at risk for hemorrhage~~, consider ordering blood~~		\| considerations_preoperative = Type and cross patients at risk for hemorrhage
	\| considerations_intraoperative =		\| considerations_intraoperative =
	\| considerations_postoperative = PONV		\| considerations_postoperative = PONV
	}}		}}
			A '''hysterectomy''' is performed for a variety of indications, including uterine cancer, postpartum hemorrhage, fibroids, abnormal uterine bleeding, and endometriosis. It is most commonly performed laparoscopically, and is increasingly an outpatient procedure.<ref>{{Cite journal\|last=Morgan\|first=Daniel M.\|last2=Kamdar\|first2=Neil S.\|last3=Swenson\|first3=Carolyn W.\|last4=Kobernik\|first4=Emily K.\|last5=Sammarco\|first5=Anne G.\|last6=Nallamothu\|first6=Brahmajee\|date=2018-04\|title=Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women\|url=http://dx.doi.org/10.1016/j.ajog.2017.12.218\|journal=American Journal of Obstetrics and Gynecology\|volume=218\|issue=4\|pages=425.e1–425.e18\|doi=10.1016/j.ajog.2017.12.218\|issn=0002-9378}}</ref> It is the second-most common gynecological surgical procedure after cesarean section in the United States<ref>{{Cite web\|title=Plotting the downward trend in traditional hysterectomy\|url=https://ihpi.umich.edu/news/plotting-downward-trend-traditional-hysterectomy\|access-date=2021-03-30\|website=ihpi.umich.edu\|language=en}}</ref>, and it is frequently performed alongside other procedures including bilateral salpingo-oophrectomy and pelvic/paraaortic lymph node dissection.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>
	.

	== Preoperative management ==		== Preoperative management ==

Chris.Rishel at 16:56, 12 May 2021

2021-05-12T16:56:38Z

← Older revision		Revision as of 09:56, 12 May 2021
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	~~Hysterectomies can be~~ performed for a variety of indications, including uterine cancer, postpartum hemorrhage, fibroids, abnormal uterine bleeding, and endometriosis. It is most commonly performed laparoscopically, and is increasingly an outpatient procedure.<ref>{{Cite journal\|last=Morgan\|first=Daniel M.\|last2=Kamdar\|first2=Neil S.\|last3=Swenson\|first3=Carolyn W.\|last4=Kobernik\|first4=Emily K.\|last5=Sammarco\|first5=Anne G.\|last6=Nallamothu\|first6=Brahmajee\|date=2018-04\|title=Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women\|url=http://dx.doi.org/10.1016/j.ajog.2017.12.218\|journal=American Journal of Obstetrics and Gynecology\|volume=218\|issue=4\|pages=425.e1–425.e18\|doi=10.1016/j.ajog.2017.12.218\|issn=0002-9378}}</ref> It is the second-most common gynecological surgical procedure after cesarean section in the United States<ref>{{Cite web\|title=Plotting the downward trend in traditional hysterectomy\|url=https://ihpi.umich.edu/news/plotting-downward-trend-traditional-hysterectomy\|access-date=2021-03-30\|website=ihpi.umich.edu\|language=en}}</ref>, and it is frequently performed alongside other procedures including bilateral salpingo-oophrectomy and pelvic/paraaortic lymph node dissection.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>		A '''hysterectomy''' is performed for a variety of indications, including uterine cancer, postpartum hemorrhage, fibroids, abnormal uterine bleeding, and endometriosis. It is most commonly performed laparoscopically, and is increasingly an outpatient procedure.<ref>{{Cite journal\|last=Morgan\|first=Daniel M.\|last2=Kamdar\|first2=Neil S.\|last3=Swenson\|first3=Carolyn W.\|last4=Kobernik\|first4=Emily K.\|last5=Sammarco\|first5=Anne G.\|last6=Nallamothu\|first6=Brahmajee\|date=2018-04\|title=Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women\|url=http://dx.doi.org/10.1016/j.ajog.2017.12.218\|journal=American Journal of Obstetrics and Gynecology\|volume=218\|issue=4\|pages=425.e1–425.e18\|doi=10.1016/j.ajog.2017.12.218\|issn=0002-9378}}</ref> It is the second-most common gynecological surgical procedure after cesarean section in the United States<ref>{{Cite web\|title=Plotting the downward trend in traditional hysterectomy\|url=https://ihpi.umich.edu/news/plotting-downward-trend-traditional-hysterectomy\|access-date=2021-03-30\|website=ihpi.umich.edu\|language=en}}</ref>, and it is frequently performed alongside other procedures including bilateral salpingo-oophrectomy and pelvic/paraaortic lymph node dissection.<ref>{{Cite book\|last=Jaffe\|first=Richard A\|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805\|title=Anesthesiologist's manual of surgical procedures\|last2=Schmiesing\|first2=Clifford A\|last3=Golianu\|first3=Brenda\|date=2014\|isbn=978-1-4963-0594-7\|language=English\|oclc=888551588}}</ref>

	{{Infobox surgical case reference		{{Infobox surgical case reference

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2021-03-30T23:30:38Z

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Hysterectomies can be performed for a variety of indications, including uterine cancer, postpartum hemorrhage, fibroids, abnormal uterine bleeding, and endometriosis. It is most commonly performed laparoscopically, and is increasingly an outpatient procedure.<ref>{{Cite journal|last=Morgan|first=Daniel M.|last2=Kamdar|first2=Neil S.|last3=Swenson|first3=Carolyn W.|last4=Kobernik|first4=Emily K.|last5=Sammarco|first5=Anne G.|last6=Nallamothu|first6=Brahmajee|date=2018-04|title=Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women|url=http://dx.doi.org/10.1016/j.ajog.2017.12.218|journal=American Journal of Obstetrics and Gynecology|volume=218|issue=4|pages=425.e1–425.e18|doi=10.1016/j.ajog.2017.12.218|issn=0002-9378}}</ref> It is the second-most common gynecological surgical procedure after cesarean section in the United States<ref>{{Cite web|title=Plotting the downward trend in traditional hysterectomy|url=https://ihpi.umich.edu/news/plotting-downward-trend-traditional-hysterectomy|access-date=2021-03-30|website=ihpi.umich.edu|language=en}}</ref>, and it is frequently performed alongside other procedures including bilateral salpingo-oophrectomy and pelvic/paraaortic lymph node dissection.<ref>{{Cite book|last=Jaffe|first=Richard A|url=http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=3418805|title=Anesthesiologist's manual of surgical procedures|last2=Schmiesing|first2=Clifford A|last3=Golianu|first3=Brenda|date=2014|isbn=978-1-4963-0594-7|language=English|oclc=888551588}}</ref>

{{Infobox surgical case reference
| anesthesia_type = General
| airway = Endotracheal tube
| lines_access = Peripheral IV
| monitors = Standard ASA
5 lead EKG
| considerations_preoperative = Type and cross patients at risk for hemorrhage, consider ordering blood
| considerations_intraoperative =
| considerations_postoperative = PONV
}}

.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Respiratory
|Many gynecological tumors are associated with cigarette smoking, assess for preexisting lung disease
|-
|Gastrointestinal
|
|-
|Hematologic
|Patients with abnormal uterine bleeding, fibroids frequently have chronic anemia
|-
|Renal
|
|-
|Endocrine
|
|-
|Labs
|Type and cross all patients

CBC in chronic anemia
|}

=== Patient preparation and premedication ===

* Midazolam
* Consider scopolamine patch in young women at high risk for PONV

=== Regional and neuraxial techniques ===

* Spinal or epidural can be considered in open approach

== Intraoperative management ==

=== Monitoring and access ===

* Standard ASA monitors
* 5-lead EKG
* Urinary catheter
* 1-2 peripheral IVs (16-18 gauge)
* In hemorrhaging patients, consider arterial line and central access

=== Induction and airway management ===

* Standard induction
* In unstable patients including hemorrhaging patients, consider etomidate (BP control) and rapid sequence intubation (RSI)

=== Positioning ===

* Dorsal lithotomy position, arms tucked

=== Maintenance and surgical considerations ===

* Intraoperative insufflation may cause:
** Resp: atelectasis, decrease FRC, increase PIPs, and increase CO2. May also cause endobronchial intubation
** GI: gastric content regurgitation
** Cardiac: decreased cardiac output

=== Emergence ===

* PONV prophylaxis, especially in young women at higher risk

== Postoperative management ==

=== Disposition ===

* PACU

=== Pain management ===

* NSAIDs, acetaminophen for mild pain
* Opioids for breakthrough pain. Consider PCA for open cases

=== Potential complications ===

* PONV
* Conversion to laparotomy (3.9%)
* Urinary tract injury
* Bowel injury
* Vaginal cuff dehiscence
* Hemorrhage

== Procedure variants ==

{| class="wikitable"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]