Total abdominal hysterectomy ± BSO

Steps

1. Supine, catheter; Pfannenstiel or midline incision.
2. Pack bowel; self-retaining retractor (Balfour / Landon).
3. Clamp cornua for traction (Kocher’s / Spencer Wells).
4. Clamp–cut–tie round ligaments; open broad ligament.
5. BSO: see the ureter, then clamp infundibulopelvic ligament. Keeping ovaries: clamp tube + utero-ovarian ligament.
6. Open vesico-uterine peritoneum; push bladder down.
7. Skeletonise and clamp uterine vessels at the internal os.
8. Clamp cardinal and uterosacral ligaments close to the cervix.
9. Open vagina, remove uterus; close the vault including angles.
10. Check haemostasis and ureters; count; close.

Consent risks