Prepared by:

Sheena Mae M. Atienza

BSN
LEVEL IV-B

Total Abdominal Hysterectomy
Bilateral Salpingo Oophorectomy
(TAH BSO)

is a surgical procedure in which the health care provider
removes the uterus including the cervix and the ovaries
including the fallopian tubes.
The scar may be horizontal or vertical, depending on the
reason the procedure is performed, and the size of the
area being treated. It is performed to treat cancer of the
ovary(s) and uterus, endometriosis, and large uterine
fibroids.
TAHBSO may also be done in some unusual cases of
very severe pelvic pain, after a very thorough evaluation
to identify the cause of the pain, and only after several
attempts at non-surgical treatments.

Clearly a woman cannot bear children herself after this
procedure, so it is not performed on women of
childbearing age unless there is a serious condition,
such as cancer.
TAHBSO allows the whole abdomen and pelvis to be
examined, which is an advantage in women with cancer
or investigating growths of unclear cause.

Total Abdominal Hysterectomy
Bilateral Salpingo Oophorectomy
(TAH BSO)

Hysterectomy may be total, as removing
the body and cervix of the uterus or partial,
also called supra-cervical..
Salpingo refers specifically to the fallopian
tubes which connect the ovaries to the
uterus.
Oophorectomy is the surgical removal of
an ovary or ovaries.

Total Abdominal Hysterectomy
Bilateral Salpingo Oophorectomy
(TAH BSO)

Indications OF TAH-BSO
Hysterectomy is often performed on cancer paitients or
to relieve severe pelvic pain from things like,
endometriosis or adenomyosis..
Hysterectomy is also used as a last resort for postpartum
obstetrical haemorrhage or uterine fibroids that cause
heavy or unusual bleeding and discomfort in some
women.
Transsexuals undergoing sex reassignment surgery as
part of a female-to-male (FTM) transition commonly have
hysterectomies and oophorectomies to remove the
primary sources of female hormone production.

Total Abdominal Hysterectomy
Bilateral Salpingo Oophorectomy
(TAH BSO)

Risks & Side Effects OF TAH-BSO
Hysterectomy has been found to be associated with increased
bladder function problems, such as incontinence
When the ovaries are also removed, estrogen levels will fall.
This removes the protective effects of estrogen on the
cardiovascular and skeletal system.
A menopausal woman has a three times greater risk of developing
cardiovascular disease such as atherosclerosis, peripheral artery
disease or of having a heart attack when compared to
premenopausal women
Studies have also found that the risk of developing osteoperosis
may increase.

Total Abdominal Hysterectomy
Bilateral Salpingo Oophorectomy
(TAH BSO)

Surgical Procedure
Preparation and Positioning
The patient is in supine; arms may be extended on arm boards.
Apply electrosurgical dispersive pad.
Skin Preparation
Vaginal and abdominal skin preparations are required.
Put the patients legs in a frog-like position and prepare as for
Dilatation and Curettage,
Insert a foley catheter and connect to continuous drainage.
Return the patients leg to their original position, and replace the
safety belt.
For abdominal preparation using iodine solution, begin at the
incision extending from nipple to mid-thighs, and down to the tables
at the sides

Total Abdominal Hysterectomy
Bilateral Salpingo Oophorectomy
(TAH BSO)

Draping
Folded towel and a transverse or laparotomy sheet
Procedure
1. A pfannenstiel or the bikini incision is employed.
2. The peritoneal cavity is entered and a self retaining retractor place.
3. The patient is placed in Trendelenburg position, and the intestines
are protected with warm moist (saline) laparotomy pads.
4. The round ligaments of the uterus of the uterus are ligated, divided.
5. Sutured and tagged with a hemostat.
6. After identifying the ureters, the broad ligaments are Incised, and the
bladder is reflected from the anterior aspect of the cervix.
7. The infundibulopelvic ligaments are ligated and divided.
8. The uterosacral ligaments are ligated and divided.
9. The ligaments are likewise divided. The vagina is incised
circumferentially and the uterine specimen removed.

Total Abdominal Hysterectomy
Bilateral Salpingo Oophorectomy
(TAH BSO)

A free sponge may be placed in the vagina prior to closure.
After hemostasis is secured, the vaginal cuff is closed; a drain may
be used.
The stumps of the uterosacral and round ligaments are sutured to
the angles of the vaginal closure.
The pelvic peritoneum is approximated, and the wound is closed.
The free sponge is removed

Total Abdominal Hysterectomy
Bilateral Salpingo Oophorectomy
(TAH BSO)


NURSING RESPONSIBILITIES
Preoperatively
Before the patient is brought back to the room, the scrub nurse
makes sure that the proper instruments and supplies are
available for the procedure. She opens the appropriate sterile
packs and trays before scrubbing in to organize and count them.
After the patient is brought back to the room and anesthetized,
she may perform the abdominal and vaginal prep with an iodine
or chlorhexidine solution. She then gowns and gloves the
surgeons and helps with draping.

Total Abdominal Hysterectomy
Bilateral Salpingo Oophorectomy
(TAH BSO)


NURSING RESPONSIBILITIES
Intra-operatively
Once the incision is made, the surgeons enter the abdominal
cavity and visualize the uterus. The scrub nurse must have the
appropriate self-retaining retractor and blades available. At
various times during the procedure, he may be required to hold
the self-retainer or additional retractors in certain positions.
Removing the uterus, fallopian tubes and ovaries involves
several steps that are repeated on both sides. The nurse must
hand the surgeons the proper clamps, scissors and sutures
quickly to allow for an efficient and safe procedure. Once the
uterus is out, he will hand it to the circulating nurse to be sent for
specimen, and count the instruments and supplies as the
surgeons close the vaginal canal. He will count again when they
begin closing the abdomen.


Total Abdominal Hysterectomy
Bilateral Salpingo Oophorectomy
(TAH BSO)

Postoperatively
Once the procedure is finished, the scrub nurse helps the
surgeons clean the patient of prep solution and blood. She then
assists in dressing the incision. The instruments must be returned
to their trays and brought to the decontamination room, while the
operating room is cleaned and prepared for the next operation.
1. Determines patients immediate response to surgical intervention.
2. Monitor patients physiologic status.
3. Assess patients pain level and administers appropriate pain relief
measures.
4. Maintains patients safety(airway, circulation, prevention of injury)
5. Administer medication, fluid and blood component therapy, if
prescribed.
6. Assess patients readiness for transfer to in hospital unit or for
discharge home based on institutional policy.

Total Abdominal Hysterectomy
Bilateral Salpingo Oophorectomy
(TAH BSO)

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