Hystérectomie voie basse

technique operatoire : Hysterectomie Vaginale par voie basse

 

Temps opératoires

Rôle de l’instrumentiste

 Champage

 Aide à droite du patient + instrumentiste  Jambières x 2Champ sous fessierChamp de têteChamp de pied
Mise en place de l’aspiration avec sa canuleMise en place du bistouri électrique  

Intervention

Traction du col Pince de Pozzi ou de Museux
Injection de 20cc de Xylocaïne adrénalinée sue l’Exo col Cupule avec 1 flacon de Xylocaïne adrénalinée + 40 CC de Na cl + seringue de 20 CC + aiguille IM
Exposition Mise en place des Valves de Briesky
Incision circulaire du col Pince à disséquerBistouri lame 23CompressesCiseaux de Mayo
Incision médiane et verticale Bistouri lame 23Pince de PozziCiseaux de MayoPinces d’Allis x2
Dissection vésico-utérine jusqu’au cul de sac intervésico-utérin, Repérage du péritoine et finition de l’incision vaginale en arrière Pince à disséquerCiseaux de BoetcherVicryl 0-30 + porte aiguille
Ligature et section des ligaments urétéro-sacrés, cardinaux, des pédicules utérins (doublés).Repérage des ligaments ronds en arrière
Pince Jean-Louis FaureBengoléaCiseauxVicryl 1-36 + pince à garder
Bascule de l’utérus en arrière et libération
Pince de Museux ou PozziRoger x 2 (trompes)Ciseaux

Evacuation de la pièce opératoire

Vérification de l’état des ovaires

 
Mise en place de la sonde urinaire Sonde urinaire de 14 ch + poche de recueilSeringue 10 CC + H2OContrôle de la couleur des urines
Vérification de l’hémostase Pince à disséquerCompressesBistouri électrique
Fermeture du Douglas par surjet avec extériorisation des pédicules Vicryl 0-30 + porte aiguilleCiseaux à filPince à griffes
Fermeture vaginale Vicryl 1-36 + porte aiguilleCiseaux à fil

Compte des compresses

Vidange de la vessie et contrôle de la coloration des urines

 

Pansement vaginal à visée hémostatique Mèche prostatique vaselinéPince à disséquer
 Pansement + protection à usage unique + culotte à usage unique
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