Steps of Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH-BSO)
Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) involves a systematic approach to remove the uterus, cervix, fallopian tubes, and ovaries through an abdominal incision. 1
Preoperative Considerations
- Appropriate bowel preparation should be completed, especially if there's potential for bowel resection 1
- Patient should be positioned for optimal exposure with preparation for a vertical midline abdominal approach 1
Surgical Procedure Steps
1. Abdominal Entry and Exploration
- Make a paramedian incision to access the abdominal cavity 1
- Thoroughly explore the entire abdominal cavity to assess disease extent 1
- Inspect and palpate abdominal organs including liver, diaphragm, omentum, and peritoneal surfaces 2
- Obtain peritoneal washings for cytology 2
2. Vascular Control and Organ Removal
- Complete excision of the lumbar-ovarian vessels bilaterally 1
- Ligate and divide the round ligaments bilaterally 1
- Identify, ligate and divide the uterine vessels 1
- Perform total hysterectomy with complete removal of the uterus and cervix 2
- Remove fallopian tubes and ovaries bilaterally 2
- Complete vaginal closure 1
3. Additional Procedures (Based on Indication)
- Perform infracolic omentectomy if indicated 1
- Consider appendectomy when appropriate 1
- Assess pelvic and para-aortic lymph nodes, removing suspicious or enlarged nodes 1
- Take routine peritoneal biopsies from multiple sites if indicated 1
4. Closure
- Ensure hemostasis throughout the surgical field 1
- Close the abdominal wall in layers 1
- Document operative findings and procedures performed in detail 1
Special Considerations
- For gynecologic malignancies, the standard treatment is TAH-BSO with appropriate surgical staging 2
- Lymphadenectomy may be performed based on disease indication, though its routine use in early endometrial cancer remains controversial 2
- For endometrial cancer, abdominal organs should be carefully inspected and palpated during the procedure 2
- In cases of cervical involvement, radical hysterectomy with BSO may be preferred 2
Surgical Approach Variations
- TAH-BSO can be performed via open abdominal approach or laparoscopically (LAVH-BSO) 3
- Laparoscopic approach offers advantages of shorter hospital stay (3.8 vs 6 days) and reduced postoperative analgesia requirements 3
- Combined procedures with colorectal surgeons may be performed for conditions involving both gynecological organs and colorectum 4
Post-operative Considerations
- For patients undergoing TAH-BSO for endometriosis, early initiation of hormone replacement therapy (within 6 weeks) does not appear to increase risk of symptom recurrence 5
- For premenopausal women undergoing TAH-BSO, appropriate hormone replacement therapy should be considered 6
- Patients with hysterectomy and BSO not using hormone therapy may have a slightly increased risk of venous thrombosis 7