GYN ABDOMINAL SURGERY: BENIGN vs. MALIGNANT CASES. - PowerPoint PPT Presentation

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GYN ABDOMINAL SURGERY: BENIGN vs. MALIGNANT CASES.

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GYN ABDOMINAL SURGERY: BENIGN vs. MALIGNANT CASES. What ARE you thinking? PostOP Considerations Main Considerations All Instrumentation and Supplies visually and ... – PowerPoint PPT presentation

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Title: GYN ABDOMINAL SURGERY: BENIGN vs. MALIGNANT CASES.


1
GYN ABDOMINAL SURGERYBENIGN vs. MALIGNANT CASES.
  • What ARE you thinking?

2
Tammy Webb-Ryan, C.S.T., B.A., J.D.Principal
Surgical Technologist, GYN Oncology/RoboticsUCSF
Medical Center, Mt. Zion Campus.Surgical Skills
Instructor,Mt. Diablo Adult Education Center
3
Discussion Points
  • Various types of pathology that you may
    encountered during an abdominal procedure.
  • Types of surgeries that may be performed.
  • Knowledge of key Surgical Services
  • Important considerations for the Surgical
    Technologist.
  • The goal today is to discuss what additional
    considerations (if there are any) we may have
    when a case is malignant vs. benign.

4
Pathology
  • Benign
  • Uterine Fibroids
  • Ovarian Cyst
  • Simple
  • Endometrial
  • Dermoid

5
Surgical Procedures
  • Myomectomy
  • The removal of Uterine Fibroids.
  • Large blood loss
  • Sutures
  • Medication
  • Vasopressin

6
Surgical Procedures
  • Ovarian Cystectomy
  • Removal of cyst contents and cyst wall.
  • Blood loss
  • Sutures
  • Pathology
  • Frozen
  • Fresh
  • Permanent

7
Surgical Procedure
  • TAH (Total Abdominal Hysterectomy) or Supra
    Cervical Hysterectomy
  • Removal of the Uterus and Cervix
  • Position
  • Blood Loss
  • Instrumentation
  • Sutures
  • Additional procedures if needed
  • Cysto (if Bladder has been injured)
  • Pathology
  • Permanent
  • Fresh

8
Surgical Procedure
  • Total Abdominal Hysterectomy (TAH)
  • Supra Cervical (Partial) Hysterectomy

9
PATHOLOGYMalignancy
  • Adenocarcinoma
  • Adeno Gland
  • Carcinoma Cancer
  • Types of tumors
  • Serous
  • Endometrial
  • Mucinous
  • Clear Cell
  • Undifferentiated

10
This Pathology Affects What?
  • Fallopian Tubes
  • Ovaries
  • Uterus
  • Cervix

11
Primary Surgical Procedures That May Be Performed
  • RADICAL HYSTERECTOMY
  • TAH, BSO
  • USO/BSO
  • TUMOR DEBULKING

12
Cervical Cancer
13
Surgical Procedures
  • Cervical Cancer
  • Radical Hysterectomy
  • Removal
  • Bilateral tubes and ovaries
  • Uterus
  • Cervix
  • A portion of the Vagina
  • Parametrial tissue (tissue lateral to the uterus)

14
Ovarian Cancer
15
Surgical Procedure
  • Ovarian Cancer
  • TAH BSO (Total Abdominal Hysterectomy, Bilateral
    Salpingo-Oopherectomy)
  • Removal
  • Uterus
  • Cervix
  • Tubes
  • Ovaries

16
Endometrial Cancer
17
Surgical Procedure
  • Endometrial Cancer
  • Cancer of the Uterine Lining
  • Removal
  • Uterus
  • Bilateral Tubes and Ovaries
  • Cervix
  • Possibly
  • Portion of the Vagina
  • Parametrial Tissue
  • Radical Hysterectomy (if the Endometrial Cancer
    has spread to the Cervix)

18
What Should You Know?
  • Knowledge Of These Services May Be Helpful
  • GYN
  • GENERAL
  • UROLOGY
  • VASCULAR
  • THORACIC

19
Surgical Services You Need To Know.
  • GYN
  • Pelvic Exenteration
  • Hysterectomy
  • TAH
  • Radical
  • Ovarian Cystectomy
  • Myomectomy
  • Fibroids
  • USO BSO
  • Pelvic Tumor Debulking

20
Surgical Services You Need To Know (cont.)
  • GENERAL
  • Colo-Rectal
  • Colon Resection
  • Sigmoid Colectomy
  • Omentectomy
  • Biopsy Of The Omentum
  • Appendectomy

21
Surgical Services You Need To Know (cont.)
  • UROLOGY
  • Cystectomy
  • Ileal Conduit
  • Neo Bladder
  • Cysto
  • Placement of Ureteral Stent

22
Surgical Services You Need To Know (cont.)
  • VASCULAR
  • Basic Skills
  • Vein and Artery Repair
  • Peripheral Vascular Surgery
  • AV Fistula
  • Fem-Fem
  • Fem-Pop

23
Surgical Services You Need To Know (cont.)
  • THORACIC
  • Chest Tubes
  • Biopsy of the Diaphragm
  • Pleura Repair

24
What Should You Be Thinking If The Case Is
Scheduled As Malignant.
  • How do you know?
  • Surgeon
  • GYN Oncologist
  • Case that is scheduled
  • Radical Hysterectomy
  • Pelvic Exenteration
  • USO/BSO

25
PreOP Considerations
  • Is the case scheduled correctly?
  • Is it truly a TAH, BSO or has the pt already had
    a Hysterectomy.
  • Check Patient Consent.
  • Patient Position
  • Supine vs. Lithotomy
  • Patient Size
  • Instrumentation/Supplies

26
Possible Instrumentation
  • GYN Tray (Hysterectomy)
  • Retractor Tray
  • Balfour
  • OSullivan/OConner
  • Bookwalter
  • PRN
  • Cysto Set Up
  • Basic Instruments for Appy and Omentectomy if
    needed
  • Colo Rectal Instrumentation
  • Sigmoidoscope

27
Possible Supplies
  • Basic Hysterectomy Supplies
  • Catheterization
  • 2 Way Foley
  • 3 Way Foley
  • Cysto Supplies
  • Stents
  • Guide Wires
  • Sigmoid Colectomy
  • Staplers
  • EEA Sizers
  • Anything needed to maintain Bowel Technique
  • Sigmoidoscope Supplies

28
TIME OUT!
  • Be an ACTIVE participant in the Time Out.
  • Your questions and concerns help to facilitate a
    smooth procedure and ultimately better Patient
    Care.
  • Pathology
  • Frozen Sections
  • Research Possibilities

29
IntraOP Considerations
  • CANCER
  • STAGING
  • Omentectomy
  • Lymph Node Dissection
  • Appendectomy
  • Various Biopsies If Needed

30
Lymph Node Dissection
  • Lymph Nodes
  • Pelvic
  • Obturator
  • Common Iliac
  • Para Aortic

31
Specimen
  • Frozen
  • Uterus
  • Cervix
  • Tubes and Overies
  • Permanent
  • Biopsies
  • Omentum
  • Lymph Nodes
  • Fresh
  • Research

32
Specimen Cont.
  • Research Cont.
  • Primary Surgery
  • Ovary
  • Pelvic Mass
  • Adnexal Mass
  • Fallopian Tubes
  • Uterus
  • Cervix
  • Metastatic Tumor from Gynecologic Primary
  • Omentum Tumor (Common for Ovarian)
  • Acites (Usually Ovarian)

33
Specimen Cont.
  • Recurrent Surgery
  • No Primary Removal
  • Look At Any Tumor Removed
  • Diagnosis Cancer
  • Normal Tissue
  • Ovarian
  • Uterus May Be A Normal Source
  • Endometrial
  • May Be Normal Myometrium

34
PostOP Considerations
  • Main Considerations
  • All Instrumentation and Supplies visually and
    verbally counted.
  • Patient Position
  • Number of Specimen
  • Write down all specimen and confirm with
    Circulating Nurse.

35
Thank You!!
  • AST (Association of Surgical Technologist)
  • John Chan, M.D., Director of Gynecologic Oncology
  • Lee-May Chen, M.D., Assistant Professor of
    Gynecologic Oncology
  • Alison Jacoby, M.D., Director of the
    Comprehensive Fibroid Center
  • Pat Glenn, Pathology Technologist, Gynecology
    Oncology Tissue Bank
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