Vaginal and abdominal preparation

Vaginal Preparation

The vagina and surrounding surgical field should be prepped using iodine if no allergic contra-indication, taking care not to provoke bleeding.

An iodine-soaked swab attached to a sponge holder is then carefully placed into the vagina for manipulation to aid with bladder reflection and performing the colpotomy in the event of hysterectomy.

Care must be taken to ensure the entire metal instrument is wrapped in ribbon gauze to avoid inadvertent direct contact with the vagina which risks accidental burns when monopolar diathermy is used.

Abdominal Skin Preparation

The abdomen is prepped from xiphisternum to pubic bone plus the groin, mons pubis and top of the thighs using an appropriate antiseptic skin preparation fluid such as ‘ChloraPrep’ (chlorhexidine gluconate and isopropyl alcohol, BD UK).

Drapes

Each leg is draped in transparent sterile leggings (Picture A). The use of transparent leg drapes enables 2 hourly intra-operative leg assessments to be carried out by theatre staff (although we do no use IR, prolonged Lloyd-Davis positioning can cause peripheral nerve injury or pressure sores). It also allows any PV bleeding to be seen easily.

A transparent adhesive abdominal drape can be used to maximise sterility and protect against the intra-operative transfer of skin flora into the open wound (see picture B to the left). This is large enough to cover the sides, top and bottom and ensure an adequate surgical field. The transparent drape enables assessment of all blood loss (from the surgical field and vaginally) which ensures the team are fully aware of the ongoing blood loss throughout the whole procedure.

A self-adhesive drape is stuck to the leg drapes and the operating table between the legs to form a funnel into a bucket lined with a plastic bag. This ensures all blood lost vaginally can be easily collected and weighed.