Total Abdominal Hysterectomy Bilateral Saphingo-Oophorectomy (TAHBSO) is a surgi cal procedure in which the health care provider removes

the uterus including the cervix and the ovaries including the fallopian tubes. The scar may be horizontal or vertical, depending on the reason the procedure is performed, and the size of the area being treated. It is performed to treat can cer of the ovary(s) and uterus, endometriosis, and large uterine fibroids. TAHBSO may also be done in some unusual cases of very severe pelvic pain, after a very thorough evaluation to identify the cause of the pain, and only after sev eral attempts at non-surgical treatments. Clearly a woman cannot bear children herself after this procedure, so it is not performed on women of childbearing age unless there is a serious condition, such as cancer. TAHBSO allows the whole abdomen and pelvis to be examined, which is an advantage in women with cancer or investigating growths of unclear cause. SURGICAL PROCEDURE OF TAHBSO Preparation and Positioning of the Patient The patient is supine; arms may be extended on arm boards. Apply electrosurgical dispersive pad. Skin Preparation A vaginal and an abdominal preparation are required. Put the patient s legs in a frog-like position and prepare as for Dilatation a nd Curettage, Insert a Foley catheter and connect to continuous drainage. Return the patient s leg to their original position, and replace the safety be lt. For abdominal preparation using iodine solution, begin at the incision exten ding from nipple to mid-thighs, and down to the tables at the sides Procedure Draping Folded towel and a transverse or laparatomy sheet Procedure A pfannenstiel or the bikini incision is employed. The peritoneal cavity is entered and a self retaining retractor place. The patient is placed in Trendelenburg position, and the intestines are protected with warm moist (saline) laparotomy pads. The round ligaments of the uterus of the uterus are ligated, divided. Sutured and tagged with a hemostat. After identifying the ureters, the broad ligaments are Incised, and the bladder is reflected from the anterior aspect of the cervix. The infundibulopelvic ligaments are ligated and divided. The uterosacral ligaments are ligated and divided. The ligaments are likewise divided. The vagina is incised circumferentia lly and the uterine specimen removed. A free sponge may be placed in the vagina prior to closure. After hemostasis is secured, the vaginal cuff is closed; a drain may be used. The stumps of the uterosacral and round ligaments are sutured to the ang les of the vaginal closure. The pelvic peritoneum is approximated, and the wound is closed. The free sponge is removed