Dr. Insaf Shaban, RN, RM, DMid

AL al-Bayt University

Instruments & Procedures

of Obstetric Surgery

1 dr.Shaban

2

Non sterile team member- also

called circulator

• Don OR attire and personal protective equipment (PPE)

• Prepare operating room

• Transport of patient to the OR and transfer to OR bed

• Positioning of patient

• Assisting the anesthesia provider

• Assisting with draping of patient

• Connecting various cords and tubing

dr.Shaban 2

3 3

Preoperative Procedures

Preliminary duties

Preoperative instruction (Explaining all aspects of the surgical procedure to the patient

Administrative and legal tasks (Obtaining signed informed consent forms).

Easing the patient’s fears

Preparing the Patient

Initial tasks

Gowning and position the patient

Surgical skin preparation

Preparing the surgical room

dr.Shaban 3

4

Intra operative Nursing Care

Risk of infection related to invasive procedure and exposure to pathogens.

Risk for injury related to positioning during surgery.

Risk of injury related to foreign objects left in the wound.

Risk for injury related to chemical, physical, and electrical hazards.

Risk for impaired tissue integrity.

Risk for alteration in fluid and electrolyte balance related to abnormal blood loss and NPO status.

Nurses are responsible for managing six areas

of risk:

dr.Shaban 4

5

Sterile Field

The area surrounding the client and the surgical

site that is free from all microorganisms.

Elements of Aseptic Technique

Sterile gowns and gloves.

Sterile drapes used to create sterile field.

Sterilization of items used in sterile field.

dr.Shaban

6 dr.Shaban 6

dr.Shaban 7

8 8

Scalpels

Very sharp knife

Handle and blade are packaged separately

Used to make surgical cuts called incisions

Different sizes and styles ( 3°; 4°)

dr.Shaban 8

9 9

Instruments Used in Common

Scissors :Four different types

Utility: Cut material that may dull the blade

Suture: Remove sutures

Dissecting: Cut soft tissue; Different sizes

Blade can be straight, curved, blunt or pointed

dr.Shaban

10 10

Forceps

Two Types

Tooth forceps

Non-tooth forceps

dr.Shaban 10

11

Instruments Used in Surgery (cont.)

Grasping and Clamping Instruments to control blood flow

dr.Shaban

12 12

Needle holders

Locking forceps

Similar to hemostats

Holds suture needles when installing stitches

dr.Shaban

GYN Instruments

13 dr.Shaban

14

Avard Weighted Speculum

This vaginal speculum is

used to retract the posterior

vaginal wall. The weight at

the bottom hangs down and

holds the wall open. The

groove along the back of the

speculum allows blood and

fluid to spill out of the field.

dr.Shaban

15

Graves Vaginal Speculum

This self retaining

speculum is used to

retract the vaginal

walls.

dr.Shaban

16

Hegar Uterine Dilators

These dilators are used progressively, from smallest in diameter to the largest, to dilate the cervix.

These dilators have a stopping ring to help the surgeon avoid perforating the uterus as the cervix is dilated.

dr.Shaban

17

Polyp Forceps

These grasping forceps

are used to remove

polyps from inside the

uterus. They are

inserted through the

dilated cervix and the

polyp is bluntly

extracted.

dr.Shaban

18

Sims Uterine Curettes

These sharp and/or

curettes are used to

scrape the interior walls

of the uterus in a D & C

procedure. They remove

excess tissue that may be

causing heavy bleeding

or pain. This tissue is

sent to pathology for

inspection. dr.Shaban

19

Uterine Sound

This is a measuring devise used to measure the depth of the uterus. It is inserted vaginally through the cervical opening until it touched the top of the fundus. This tells the surgeon how deep he is able to insert dilators or curettes without penetrating the uterine wall.

dr.Shaban

20

Uterine Vellsulum

The sharp penetrating jaws of this clamp are secured

to the cervix so it may be stabilized with traction

during any uterine procedure with a vaginal

approach.

dr.Shaban

21

Yankauer Suction Tip & Poole

(Multi-whole Abdominal Suction) This metal suction tip is the same as its disposable plastic

counterpart except that it is reusable.

The sheath surrounding the tip allows it to suction fluids while deep in a cavity and be atraumatic to the surrounding tissues.

dr.Shaban

22

Cone Tip Uterine Manipulator

Cohen Cannulae

Placed inside the uterus through the cervix. Used

during Laparoscopic procedures to externally

manipulate the uterus.

dr.Shaban

dr.Shaban 23

24

Sutures Used in Obstetric Operations

Absorbable sutures

Surgical gut

Plain

Chromic

Vicryl

Dexon

Nonabsorbable sutures

Silk

Nylon

Polypropylene (Prolene)

dr.Shaban 24

Preparation:

25 dr.Shaban 25

26 26 dr.Shaban 26

Way to Handle the Instruments

dr.Shaban 27

28

Counts

Initial; sponges, sharps, instruments

First closing

Final closing

Sponges

Sharps

Instruments

dr.Shaban 28

29

Surgical Intervention: Special (Practical)

Considerations in abdominal-vaginal surgery

Special considerations

Extra gloves & maybe an additional gown will be

necessary for the assistant—change after providing

intravaginal urethral support/vaginal manipulation

during suturing

Foley cath may be inserted by circulator during prep

Should be aware of potential for contamination of

field dur to vaginal and abdominal areas being

incorporated in the same drape.

dr.Shaban

Surgeries

What’s in a Name??? Surgeries are given names that describe the site

of surgery and the type of surgery performed

-ectomy: removal of an organ or gland ( e.g:

Hystrectomy; Salpengectomy)

-rrhaphy: repair ( vaginal repair

-ostomy: providing an opening or stoma (

Hystrotomy; Salpengestomy)

-plasty: formation or plastic repair ( Tuboplasty)

-scopy: looking into ( Laprascopy; hystrascopy)

dr.Shaban 30

Major Obstetric Surgeries

Cesarean section:

A surgical incision made into the abdomen and uterus to

deliver the fetus after 32 WK gestational age.

Types of Cesarean Incisions

-Lower Uterine Segment (Low Transverse)

-Classical (Vertical Midline)

dr.Shaban 31

dr.Shaban 32

dr.Shaban 33

34 34

Cesarean section

The laparotomy pads put in abdominal

cavity are all

removed & counted doubly

by surgeon himself and then by nurse.

dr.Shaban

Hystrectomy

dr.Shaban 35

dr.Shaban 36

dr.Shaban 37

Vaginal Surgery

Pros

• Minimally invasive

Less pain compared to abdominal hysterectomy

Short length of stay (LOS)

Cons

• Difficult to perform

• Reduced visualization

• Not indicated for many patients

Nulliparious

Multiple fibroids (or large masses)

Cancer

Adhesions, e.g., endometriosis, prior pelvic surgery

38 dr.Shaban 38

39 39

Aperineal drape

For operations on the perineum and

genitalia with the patient in lithotomy

position

A lithotomy drape consists of a fenestrated

sheet and two triangular leggings

dr.Shaban 39

Pelvic floor dysfunction

Cystocele-posterior bladder protrudes towards ant wall of vagina;leading to Stress incontinence-leaking of urine when coughing or sneezing due to weakened pelvic floor

Rectocele-the posterior vaginal wall becomes weak,

upon defecation the feces is pushed against the wall

instead of the rectum

Uterine prolapse-supporting structures of the uterus

and vagina are weakened causing the uterus to

protrude through the vagina dr.Shaban 40

Uterine proplase cystocele

dr.Shaban 41

42

Minar Surgical techniques

• Dilatation and curettage ( D&C)

– Performed first by dilating the cervix & evacuating the

product of conception • Mechanically scraping out of the contents (sharp curettage)

– Before 14 weeks, D&C or vacuum aspiration should be

performed

– After 16 weeks, dilatation & evacuation (D&E) is

performed • Wide cervical dilatation

• Evacuation of fetal parts

dr.Shaban

43 dr.Shaban

44 dr.Shaban

45 dr.Shaban

Suction curettage

• Is the method of choice of evacuation for complete molar pregnancies.

• Because of the lack of fetal parts a suction catheter, up to a maximum of 12 mm, is usually sufficient to evacuate all complete molar pregnancies.

46 dr.Shaban

McDonald Stitch

dr.Shaban 47

Laparscopy

Visualization of the trocar into the abdominal

cavity is performed by making a subumbilical

incision. The fascia is grasped with Kocher

clamps and a 10-12 mm incision is created in

the fascia. The peritoneum is then incised and

a blunt trocar is inserted into the abdomen

with direct visualization. A Verress needle

can be inserted at the subumbilical site

48 dr.Shaban

49 dr.Shaban

50 50

Trocar

Release fluid or gas build-ups

Sharp stylet inside cannula

dr.Shaban

51 51 dr.Shaban

dr.Shaban 52

53

Diathermy in Gynaecology- General

Use

During surgery ( Open & Laparoscopic) for Cutting &

Haemostasis.

Can be used in LSCS. No effect on the fetus.

Take care while working near vital structures.

Apply the point first , then switch on the current.

Monopolar (Electrosurgical Cutting with / without

Coagulation. Patient plate is required) & or Bipolar

can be used (Preferred in endoscopic surgery).

dr.Shaban

dr.Shaban 54

Electro surgery for Tubal Sterilisation

Tubal sterilisation is usually done either by

mini- laparotomy 0r laparoscopy with almost

equal results.

But laparoscopy requires more sophisticated

and expensive equipment and greater skills.

55

Hysteroscopy

These instruments are

used during scoping

procedures done on the

inside of the uterus. They

cannulate the cervix and

allow passage of a scope,

in-flowing fluid and out-

flowing fluid.

Electrode used during

hysteroscopic procedures. dr.Shaban

56

Surgical Room Cleanup

Place reusable instruments in a disinfectant soak that has anticoagulant properties

Place disposable waste in the sharps or biohazardous waste container

Disinfect small pieces of nonsurgical equipment.

dr.Shaban

57

End of Chapter

dr.Shaban