Surgical Technique for the Simulation of a Procedure

Ectopic pregnancy

Yenny Yurley Delgado Suarez

01200021055

Santander University
Faculty of Health Sciences
Surgical instrumentation
Gynecology
Johanna tapias rivera
 2021
1. Definition
It occurs when a fertilized egg implants and grows outside the endometrial cavity.
These occur most often in the uterine tubes.
Implantation is recorded at any point other than the uterus.

2. Indications
 Processes that prevent or delay the passage of the fertilized egg into the uterine
cavity
 Salpingitis
 Pretubal adhesions.
 Embryonic tube abnormalities (hypoplasia).
 Tumors that distort the tube (fibroids or adnexal masses).
 External migration of the ovum.
 Menstrual reflux
 Sexually transmitted disease that causes lesions in the epithelium.
 Increased receptivity of the fertilized ovum by the tubal mucosa
 Ectopic endometrial elements.
 Tubal ligation.

3. Contraindications
 Tubal vessel hemorrhage.
 Rupture of the uterine wall
 Injury of uterine vessels.
 Intestinal injury
 Tear of the mesosalpinx.
 Ovarian injury
 Hemodynamic instability.
4. Preoperative care
 Pre-surgical exam
 Clinic history.
 Gynecological examination.
 General examination
 Pelvic ultrasound.
 Pregnancy test
 The doctor should discuss with the patient the consequences of the surgery and
its effects.
 Anemia must be treated.
 Two hours before surgery, administer 2 g of cephalosporin in order to prevent
postoperative infection.

5. Protocol
 Position of the patient supine.
 Anesthesia: Regional or General
 Asepsis and antisepsis of the operative area.
 Embrocation or vaginal lavage.
 Bladder evacuation (Foley catheter 16x5-18x5).
 Organization of May tables and reservation (it will depend on the pregnancy
side).
 Compress Count
 Dressed as the surgeon.
 Dressed as the patient.
 Location of tables and surgical equipment.

6. Check list

Instrumental Medical devices Solutions and / or drugs

Sutures
Description
Flat Generic name Tradename (needle, type of Image
suture, gauge)
Skin Polymity Ethilon (ethicon) Non-absorbable-
Dermalon (covidien) synthetic suture.
Dafilon (braun) Gauge 3/0 straight
Polypropylene Prolene (ethicon) needle or 3/8 circle
Surgirpro (covidien) cutting.
Optilene (braun)
Synthetic
Aponeurosis Polyglactin 910 Vicryl (ethicon) absorbable suture 0
Polysorb (covidien) gauge needle ½
Safil (braun) round circle.

Natural absorbable
Muscle Chromed catgut Chrome Catgut suture 2/0 gauge
(Ethicon) needle ½ round
Chromic catgut circle.
(covidien)
Chromic catgut
(braun) Synthetic
Uterine tube
absorbable suture
ligation. Polyglactin 910 Vicryl (ethicon) gauge 1 or 2/0
Polysorb (covidien) needle ½ round
Safil (braun) circle.

Chromed catgut Chrome Catgut 1 or 2/0 gauge

(Ethicon) natural absorbable
Chromic catgut suture ½ round
(covidien) circle needle.
Chromic catgut
(braun)

7. Main Steps
1. Abdominal opening
2. Evacuation of large clots
3. Mobilization of the fallopian tube
4. Wound closure
5. Healing

Table arrangement
Mayo table
1. Scalpel Handle N ° 4 - Blade 20
2. Scalpel Handle No. 7-Blade 15
3. Metzembaum scissors
4. Mayo scissors straight
5. Curved Kelly forceps
6. Straight Kelly forceps
7. Kelly Adson forceps
8. Curved Rochester forceps
9. Rochester straight forceps
10. Babcock forceps
11. Allix clamp
12. Farabeuf separators
13. Clawless Dissection Forceps
14. Claw Dissection Forceps
15. Russian Dissecting Forceps

Reservation table
1. General Team
2. Coca with whey
3. Malleable valve
4. Deaver separator
5. Electrosurgical pen,
gloves, suction
rubber, Yankawer
cannula, pear
6. Clothes package
7. Backhouse field clamps
8. Foerster clamp
9. Compress and sutures
 10. Needle holder
11. Balfour Separator

8. Surgical technique

Surgical Process Instrumentation Process Image

Pfannenstiel or Median Scalpel Handle 4 Scalpel
infraumbilical abdominal Blade 20.
incision

Viewing the Farabeuf Electrosurgical

aponeurosis of Pencil Separator.
anterior rectus muscles
And hemostasis

Taking the aponeurosis of Allix forceps

rectus muscles

Aponeurosis enlargement Metzembaum scissors

Electrosurgical pencil.
Pick and cut the peritoneum
parietal. Abdominal Curved Kelly forceps
separator placement. Metzembaum scissors
curve.
Abdominal Separator
Balfour
The cavity is reached and the
clots produced by the Rubber is suction
hemorrhage that occurs due Yankawer cannula
to the rupture of the tubal
pregnancy are suctioned.

The cavity is cleaned so that Wet compresses Saline

the source of the bleeding solution
can be identified and
controlled.

The tube is held at its end, Babcock forceps

so that the mesosalpinx can Curved Kelly or Curved
be clamped, taking into
account not to compromise
ovarian vascularity.
Then it is sectioned as close
to the fallopian tube as
possible.
The fallopian tube is
released and the interstitial
tube is clamped twice to
separate it from the
myometrium.
It is sectioned using a wedge
resection and ligated to
prevent bleeding from the
tubal vessels.
The horn is received
The mesosalpinx is then
sutured with separate
stitches and the last stitch by
transfixation in order to
close the uterine wall after
excision of the tube.
Finally, the cavity including
the bottom of the pouch of
Douglas is washed to
remove the remains of the
blood clots.
Lavage of the abdominal
cavity and the abdominal
retractor is removed
Haemostasis is checked and
Rochester forceps
Curved Metzembaum
Scissors Scalpel Handle 7
Scalpel Blade 15
Rochester curved caliper
Scalpel Handle 7
Scalpel Blade 15
chromed catgut 1 or 2/0
needle ½ round circle.
Compress
Clawless dissection forceps
Needle holder
Mayo scissors
Polyglactin 910 or chrome
catgut or ½ round circle
needle.
Coca Yankawer cannula
Rubber suction
Pear
Warm saline solution
Coke
Yankawer Cannula Balfour
Abdominal Retractor
Pear
Compresses are counted Suction rubber
Warm physiological serum
Parietal peritoneum suture
Electrosurgical Pen
gripper foerter

Needle carrier
clawless dissection forceps.
Visualization and suturing of Straight mayo scissors.
the Chromed catgut 2/0 with ½
aponeurosis round circle needle.

Fatty tissue washing
Needle carrier
Dissection forceps with
claw.
Straight mayo scissors
Polyglactin 910 0-1 ½ needle
round circle

Review of fatty tissue Coke

hemostasis Saline solution
Electrosurgical Pen
Skin suture
Dissecting forceps with
claw
Small needle holder
Mayo scissors straight
Polyamide or polypropylene
2/0 or 3/0 needle 3/8 circle
Cutting
Healing
Dressing
Micropore
Opside
9. Postoperative care
 Hormonal treatment in order to avoid pregnancy in the first six months after
surgery.
 Evaluation of the main physiological mechanisms (cardiac, renal and
respiratory) that provide the best method of guiding postoperative progress
 Watch for signs of hypovolemic shock

Bibliographic references

1. Mohamed Addi, Tehuan Red Crescent Clinic, Ectopic Pregnancy

2. Carson SA, Buster JE. Ectopic pregnancy. N Engl J Med 1993; 329: 1174-81.
3. Dupuis O, Camagna O, Beniflo JL, Batallan A, Dhainault-Renolleau C, Madelenat P.
Grossesse extrauterine.
4. Encycl Med Chir. Gynecologie / Obstetrique, 5-032-A-30, 2001