Confirmation of haemostasis, drain insertion and ureteric inspection

Checking the right ureter for size and vermiculation

Abdominal wash

Prior to abdominal closure, the pelvis is washed out with warmed normal saline. Each pedicle and the vault should be systematically checked for haemostasis.

Haemostatic adjuncts

Consideration may be given to the application of a haemostatic agent – most useful for general ooze from friable tissue or raw surface where targeted ligation of a focal bleeding point is not possible. Many products are available, each with variable mechanisms of action and merit.

The SAC preference is to use Surgicel (Ethicon, UK), an oxidized regenerated cellulose haemostat.

Pelvic drain

A pelvic drain is usually placed, most often a 20-gauge Robinson’s secured with a 1-0 Silk (Ethicon, UK) suture.

Ureteric inspection

Prior to closure, both ureters should be checked for size and evidence of vermiculation; as well as inspecting the catheter bag for urine output and colour.