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

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)

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

Preoperative Counseling:

• Surgical procedure, risks, alternatives
  • Wound healing disorder
  • Infection, rarely intra-abdominal abscess requiring revision or percutaneous drainage
  • Postoperative ileus
  • Adhesions
  • Vaginal cuff insufficiency
  • Injuries to other organs, bowel, bladder, ureter
  • Subcutaneous emphysema
  • Post-laparoscopic shoulder pain syndrome
  • General surgical risks (bleeding, rebleeding, thrombosis, embolism, HIT)
  • Possible conversion to open technique in case of complications
  • Urinary retention
  • Positioning injuries
  • Burns
  • Dissemination of benign and malignant cells, in rare cases worsening of prognosis in malignancy
  • Information on alternative treatment methods
  • Risk of lymphedema with systematic lymphadenectomy
  • Sensory and movement disorder
  • Possibility of postoperative chemotherapy or radiation therapy

Nutrition and Bowel Preparation:

• Fasting 6 hours preoperatively, clear fluids allowed up to 2 hours before surgery
• No routine bowel cleansing, except for planned extensive LNE

Antibiotic Prophylaxis:

• Cefuroxime/ Metronidazole

Urinary Catheter

Sentinel Lymph Node Mapping:

• Injection of Indocyanine Green (ICG) and Tc99m preparation
• Detection with fluorescence camera (ICG) or gamma probe (Tc99m)

Monitoring in the Recovery Room:

• Vital signs monitoring
• Monitoring of urine output
• Early mobilization for thrombosis prophylaxis

Analgesia:

• Multimodal pain management (Paracetamol + NSAIDs + opioids as needed)
• For lymphadenectomy: Consider epidural catheter

Nutritional Build-up:

• Liquid diet after 6 hours, solid diet after 24 hours if uncomplicated course

Robinson Drainage

• Removal within 24–48 hours

Urinary Catheter

• Removal depending on the extent of surgery 6–24 hours postoperatively