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Salpingo-oophorectomy

Description
  • The removal of one (unilateral) or both (bilateral) fallopian tubes and corresponding ovary.


Discussion

  • This procedure may be performed in conjunction with a hysterectomy or as a separate procedure. As a separate procedure, it is usually performed for a variety of nonmalignant diseases that include acute and chronic infection, cysts, tumors, and hemorrhage owing to tubal pregnancy. Malignancy of a tube or ovary will usually necessitate a hysterectomy with excision of the opposite adnexae.


Position

  • Supine, with arms extended on armboards.


Instrumentation

  • Major tray or abdominal hysterectomy tray.
  • Internal stapling instruments.
  • Self-retraining retractor.


Supplies/ Equipment

  • Basin set
  • Blades
  • Needle counter
  • Suction
  • Solutions – saline, water
  • Sutures


Procedure

  1. The abdomen is entered through a low midline or Pfannenstiel incision, depending on the size of the patient and the known pathologic condition.
  2. The peritoneal cavity is entered and a self-retaining retractor is placed in the wound.
  3. The operating table is placed in slight Trendelenberg position, and the incision is packed with moist Lap sponges.
  4. The uterus is grasped with a tenaculum or uterine elevator, and if adhesions are present, the affected tube and ovary are isolated from surrounding organs.
  5. The tube(s) are grasped with one or two Babcock clamps. Two Kelly or uterine clamps are then placed across the ovarian vessels.
  6. The tissue is divided between the clamps with a knife, dissecting scissors, or cautery pencil. Internal staples can also be used to accomplish this task.
  7. The infundibulopelvic ligament is ligated and divided, as is the broad ligament attached to the tube and ovary. The tube and ovary are excised.
  8. If internal staples are not used, a suture ligature is used to ligate the ovarian vessels.
  9. This procedure is repeated on the other side (if bilateral).
  10. The raw surface of the ovarian ligaments left by the dissection are reperitonealized using a running suture.
  11. The wound is irrigated with warm saline, and closed in a routine fashion.


Perioperative Nursing Considerations

  1. For bilateral surgery, a sterilization permit may be required in addition to the operative permit.
  2. When the specimen is collected (if bilateral), each side should be labeled and in separate containers, depending on hospital policy.



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