Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy (TAHBSO)

This was the first operation that I had assisted when I was still a student in the university. I personally volunteered myself because I wanted to see what this operation is. My mother underwent TAHBSO when I was still young and she stayed in the hospital for over a week. I didn’t know why in the world would someone open her and take all of her reproductive system when she’s not yet in her menopausal.

Total Abdominal Hysterectomy and Bilateral Salphingo-Oophorectomy (TAHBSO) is the removal of the uterus including the cervix, tubes and ovaries using an abdominal incision.

First, let us review the basic medical terms:

Hysterectomy is the surgical removal of the uterus. This may be total (removing the body and cervix of uterus) or partial which is also called supra-cervical.

Salphingo refers to the fallopian tubes which connects the ovaries to the uterus.

Oophorectomy is the removal of a single or both ovaries via surgery.

WHEN IS TAHBSO INDICATED?

·         This is often performed on cancer patients or to relieve severe pelvic pain and heavy menstrual cycles from patients suffering from endometriosis or adenomyosis.

·         This is also used as a last option for post partum obstetrical hemorrhage or uterine fibroids that cause heavy or unusual bleeding and discomfort for some women

Side Effects & Risk of TAHBSO

·         Estrogen levels will fall, thus protective effects of this hormone on the cardiovascular and skeletal system is removed

·         Hysterectomy has been found to be associated with increased bladder function problems

·         Menopausal women have three times greater risk of developing cardio disease such as peripheral artery disease, atherosclerosis compared to premenopausal women

·         This also increases the risk of developing osteoporosis.

OR MEMOIRS

When I was in the operating room, I had fun assisting the OB residents and consultants with TAHBSO, especially those with PFC & BLND (Peritoneal Fluid Cytology and Bilateral Lymph Node Dissection). It can sometimes consume the whole 8 hour shift if you are that lucky. What I prepare when I scrub for this operation are:

·         Major Basic Set

·         Kocher Curve        

·         Heaney Forcep

·         Spencer Wells (I prefer to prepare the curve one)

·         Long Allis Forceps, Mixter Forceps

·         DeBakey forceps

·         Balfour retractor

·         Sutures such as Chromic 1, Vicryl 1, Silk 3/0 & 2/0 Multistrands

·         Round & Cutting needles

·         BLND will need malleable retractor

, vein retractor, 

deavers

The whole procedure often follows a pattern: “kochers curve, kocher’s curve, kocher’s straight, metz, suture, suture scissor". You are never going to get lost or get pissed by the surgeon if you are just paying attention.