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Perioperative management - complete hysterectomy, bilateral adnexectomy, sentinel node biopsy pelvic bilateral laparoscopic, robot-assisted laparoscopy (DaVinci)

gynecology
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Medical history

    General Medical History:

    • Pre-existing conditions (cardiovascular, pulmonary, metabolic, hematological)
    • Medication history (anticoagulants, metformin, corticosteroids)
    • Allergies (latex, contrast agents, antibiotics)

    Gynecological History:

    • Previous gynecological procedures
    • Menopausal status
    • Bleeding disorders, pain, pressure sensation in the lower abdomen

    Oncological History:

    • Previous tumor diseases
    • Genetic predisposition (e.g., BRCA, Lynch syndrome)

  2. Clinical Examination

    General Status:

    • Physical Examination (Cardiopulmonary, Abdomen, Extremities)

    Gynecological Examination:

    • Speculum Setting: Assessment of the Cervix
    • Bimanual Examination: Assessment of Uterine Size and Adnexa
    • Transvaginal Sonography for Uterine and Adnexal Tumor Evaluation
    • Rectovaginal Examination if Infiltration is Suspected
    • Renal Sonography

  3. Preoperative Diagnostics

    ExaminationObjective
    Laboratory (Blood count, Coagulation, Liver/Kidney values, CRP, Tumor marker CA-125)Exclusion of anemia, infections, organ function assessment
    ECGEspecially in patients >50 years or with cardiovascular diseases
    Pulmonary function test (in at-risk patients)If there are pre-existing pulmonary conditions
    CT Thorax/AbdomenStaging, lymph node status
    Possibly PET-CT (in high-risk tumors or unclear lymph node findings)Detection of metastases
    Possibly preoperative marking using Technetium-99m (Tc99m)Identification of sentinel lymph nodes, in addition to ICG marking
Preoperative Preparation

Preoperative Counseling:Surgical procedure, risks, alternativesWound healing disorderInfection, rar

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