GYN ABDOMINAL SURGERY: BENIGN vs. MALIGNANT CASES.

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GYN ABDOMINAL SURGERYBENIGN vs. MALIGNANT CASES.

• What ARE you thinking?

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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
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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.

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Pathology

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

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Surgical Procedures

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

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Surgical Procedures

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

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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

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Surgical Procedure

• Total Abdominal Hysterectomy (TAH)

• Supra Cervical (Partial) Hysterectomy

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PATHOLOGYMalignancy

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

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This Pathology Affects What?

• Fallopian Tubes
• Ovaries
• Uterus
• Cervix

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Primary Surgical Procedures That May Be Performed

• RADICAL HYSTERECTOMY
• TAH, BSO
• USO/BSO
• TUMOR DEBULKING

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Cervical Cancer
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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)

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Ovarian Cancer
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Surgical Procedure

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

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Endometrial Cancer
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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)

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What Should You Know?

• Knowledge Of These Services May Be Helpful
• GYN
• GENERAL
• UROLOGY
• VASCULAR
• THORACIC

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Surgical Services You Need To Know.

• GYN
• Pelvic Exenteration
• Hysterectomy
• TAH
• Radical
• Ovarian Cystectomy
• Myomectomy
• Fibroids
• USO BSO
• Pelvic Tumor Debulking

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Surgical Services You Need To Know (cont.)

• GENERAL
• Colo-Rectal
• Colon Resection
• Sigmoid Colectomy
• Omentectomy
• Biopsy Of The Omentum
• Appendectomy

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Surgical Services You Need To Know (cont.)

• UROLOGY
• Cystectomy
• Ileal Conduit
• Neo Bladder
• Cysto
• Placement of Ureteral Stent

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Surgical Services You Need To Know (cont.)

• VASCULAR
• Basic Skills
• Vein and Artery Repair
• Peripheral Vascular Surgery
• AV Fistula
• Fem-Fem
• Fem-Pop

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Surgical Services You Need To Know (cont.)

• THORACIC
• Chest Tubes
• Biopsy of the Diaphragm
• Pleura Repair

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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

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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

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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

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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

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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

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IntraOP Considerations

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

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Lymph Node Dissection

• Lymph Nodes
• Pelvic
• Obturator
• Common Iliac
• Para Aortic

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Specimen

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

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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)

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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

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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.

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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