CC BY-NC-ND 4.0 · Surg J (N Y) 2019; 05(S 01): S2-S10
DOI: 10.1055/s-0039-1678575
Precision Surgery in Obstetrics and Gynecology
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Basic Standard Procedure of Abdominal Hysterectomy: Part 1

Yuji Hiramatsu
1   Department of Obstetrics and Gynecology, Okayama City General Medical Center, Kita-Ku, Okayama, Japan
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07. März 2019 (online)


Total abdominal hysterectomy (TAH) is commonly referred to as extrafascial hysterectomy. This article explains the basic surgical procedure of TAH as taught to residents. TAH is an operation to remove the uterus with the outer wall of the uterus, and is a fundamental operation that gynecologists must master. Possible complications during TAH include ureteral injury, intestinal damage, and bladder injury. To avoid operative complications, it is important to follow the correct release layer procedure and ensure that “the uterus has been naturally removed.”

The two most important points of the authors' method to avoid complications are as follows: (1) cut sequentially from the ligament away from the ureter which moves the ureter further away from the cervix with each transection stage; (2) cut the parametrial tissue along the circumference of the cervix in the next three steps:

First step: clamping and cutting the uterine artery and upper part of the cardinal ligament; second step: clamping and cutting the sacrouterine ligament and the posterior half of the cardinal ligament; third step: clamping and cutting the vesicouterine ligament and anterior half of the cardinal ligament.

  • References

  • 1 Hiramatsu Y. Basic procedure 1. In: Hiramatsu Y, Konishi I, Sakuragi N, Takeda S. , eds. Mastering the Essential Surgical Procedures OGS Now, No.2 Total Abdominal Hysterectomy (Japanese). Tokyo: Medical View; 2010: 42-55
  • 2 Sekiba K, Hiramatsu Y. Abdominal simple total hysterectomy - focus on ureteral damage prevention. Obstetrics and Gynecology Therapy 1990; 61: 121-127
  • 3 Sekiba K, Hiramatsu Y. Abdominal Simple Hysterectomy - extrafascial hysterectomy. Obstet Gynecol Surv 1994; 5: 23-31
  • 4 Hiramatsu Y, Sekiba K. Abdominal simple hysterectomy (extrafascial method). In: Practical Methods for Hysterectomy. Tokyo: Nankodo; 1997: 15-43
  • 5 Hiramatsu Y. Accidents during laparotomy surgery: mass bleeding, secondary injuries. Obstet Gynecol 2002; 69: 1207-1215
  • 6 Hiramatsu Y. Abdominal total hysterectomy [1]. In: Japan Society Obstetrics and Gynecology ed. Obstetrics and Gynecology Surgery Standards, Tokyo: Medical View; 2005: 64-73