Soleymani majd et al.

The Surgical Steps of the SAC Technique

Supplementary material for the journal article by Soleymani majd, H. et al

The modified radical peri-partum caesarean hysterectomy (Soleymani Alazzam Collins (SAC) technique): a systematic, safe procedure for the management of severe placenta accreta spectrum (PAS)

American Journal of Obstetrics and Gynecology (2021): in press.

(Contains graphic surgical images caution advised)

Step 1: Informed Consent

Step 2: Multi Disciplinary Team

Step 3: Anaesthetic Considerations

Step 4: Patient positioning

Step 5: Vaginal Preparation

Step 6: Abdominal entry

Step 7: Intrapartum Diagnosis: Primary Survey

Step 8: Intra-operative ultrasound scanning for placental location

Step 9: Exteriorisation of uterus, incision and delivery

Step 10: Use of uterotonics

Step 11: Intrapartum Diagnosis: Secondary Survey

Step 12: Decision making for ongoing management strategy

Step 13: Closure of Hysterotomy

Step 14: Maximising surgical access

Step 15: Securing the round ligament

Step 16: Opening the pelvic sidewall & slinging the ureter

Step 17: Identifying and securing the internal iliac and uterine arteries

Step 18: Securing the infundibulo-pelvic ligament with ovarian conservation

Step 19: Opportunistic salpingectomy

Step 20: Bladder mobilisation and tips for management of the neovascularity

Step 21: Assessment of the parametrium and ureteric tunnelling

Step 22: Anterior colpotomy

Step 23: Vault closure

Step 24: Confirmation of haemostatsis, drain insertion and ureteric inspection

Step 25: Abdominal closure

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