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:
· 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.
