- The removal of one (unilateral) or both (bilateral) fallopian tubes and corresponding ovary.
- 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.
- Supine, with arms extended on armboards.
- Major tray or abdominal hysterectomy tray.
- Internal stapling instruments.
- Self-retraining retractor.
- Basin set
- Needle counter
- Solutions – saline, water
- The abdomen is entered through a low midline or Pfannenstiel incision, depending on the size of the patient and the known pathologic condition.
- The peritoneal cavity is entered and a self-retaining retractor is placed in the wound.
- The operating table is placed in slight Trendelenberg position, and the incision is packed with moist Lap sponges.
- 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.
- The tube(s) are grasped with one or two Babcock clamps. Two Kelly or uterine clamps are then placed across the ovarian vessels.
- 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.
- The infundibulopelvic ligament is ligated and divided, as is the broad ligament attached to the tube and ovary. The tube and ovary are excised.
- If internal staples are not used, a suture ligature is used to ligate the ovarian vessels.
- This procedure is repeated on the other side (if bilateral).
- The raw surface of the ovarian ligaments left by the dissection are reperitonealized using a running suture.
- The wound is irrigated with warm saline, and closed in a routine fashion.
Perioperative Nursing Considerations
- For bilateral surgery, a sterilization permit may be required in addition to the operative permit.
- When the specimen is collected (if bilateral), each side should be labeled and in separate containers, depending on hospital policy.
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