Tubal Ligation Female Sterilization Session IIIF The Subumbilical

Tubal Ligation (Female Sterilization) Session IIIF: The Subumbilical Minilaparotomy Procedure Session III F, Slide #1

Objectives By the end of this session, participants will be able to: • Describe the tasks and steps of the subumbilical minilaparotomy approach Session III F, Slide #2

The Subumbilical Minilaparotomy Procedure • The subumbilical surgical procedure is the preferred approach for postpartum clients within one week of delivery. • However, after seven days, the involution of the uterus progresses rapidly, and the uterus is no longer accessible through a subumbilical incision. • In such cases, the client should be scheduled for a suprapubic procedure after 4– 6 weeks postpartum. • The uterine elevator is not used in postpartum clients. Session III F, Slide #3

Preprocedure Assessment Steps In the preprocedure room: • Greet the client • Review relevant medical information • Verify informed consent • Verify the client’s understanding of the procedure • Check compliance with preoperative instructions • Provide sedative and analgesic • Ask the client to empty her bladder just before entering the operating theater Session III F, Slide #4

Pre-procedure Assessment Steps – In the operating room • Accompany the client into the operating theater. • Help the client onto the operating table, • Continue to maintain constant communication. • Ensure that needed equipment, instruments, and supplies are available in the operating theater. • Monitor the client’s vital signs Session III F, Slide #5

Positioning the Client for Subumbilical Minilaparotomy: Assessing the Height of the Uterine Fundus Source Engenderhealth 2015 Session III F, Slide #6

Preparing the Client’s Abdominal Area before a Subumbilical Minilaparotomy a) Cleansing the abdomen b) Postpartum client draped Session III F, Slide #7

Preparing the Abdomen: Infiltration with Local Anesthetic Session III F, Slide #8

Entering the Abdomen a) Skin incision b) Visualizing the fascia Session III F, Slide #9

Entering the Abdomen (cont. ) c) Opening the fascia d) Opening the peritoneum Session III F, Slide #10

Entering the Abdomen (cont. ) Session III F, Slide #11

Accessing the Fallopian Tubes (a) Pushing the uterus toward the opposite side of the tube being accessed b) Moving the incision to be above the tube being accessed Session III F, Slide #12

Irrigation of the Fallopian Tubes Session III F, Slide #13

Using the Tubal Hook to Retrieve the Tube Session III F, Slide #14

Grasping and Identifying the Tube (a) Grasping the tube with a baby Babcock forceps (b) Moving the tube to the opening Session III F, Slide #15

Grasping and Identifying the Tube (cont) (c) Pulling the tube out and visualizing the fimbria Session III F, Slide #16

Confirming the Fallopian Tube Session III F, Slide #17

Occluding the Tubes: Ligation and Excision Session III F, Slide #18