WEBVTT

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Now we are going to close the uterine incision

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The uterine incision, the first thing would be to identify the angle

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because that's where the most risk of bleeding occurs

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so we should be sure that we have identified and start our sutering from the angle of the uterine incision

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and we are going to use usually vciril or chromic cat gut can also be use

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the stitch is going to be continuous

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suturing, after we grasp, make sure we have got the angle we'll go by doing continuous suturing

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and sometimes if we are doing, if we are having heavy bleeding, we can use locking sutures

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but if we feel the bleeding is controlled we don't have to lock the sutures

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while the surgeon is doing this continuous suturing, the assistant's role is a big role here

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holding the uterus still, preferably by

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using a pack

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and also holding the suture also

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by following the surgeon and hold the suture tight

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and once we have done

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in this video, you'll see that the surgeon is going to close the uterine incision

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in one layer

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and now there are two schools of thoughts about the uterine closure

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either it could be closed in one layer or two layers

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some studies have shown that using one layer closure decreases operation time

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with still the same kind of results

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still some would argue that the risk of bleeding and risk of future infection

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and disheasance would increase with one layer

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both ways are acceptable

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but usually in our practice, in our set up what we practice is using two layer approach

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so we are finish putting suture with one layer, then we are repeat the same procedure and close uterine incision in two layers

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and nowadays, we have abundant closing peritonium, even after the

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this is because it heals by iteslf quickly

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and so by not closing it it decreases postoperative pain and so it is preferred to not close the xxx

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once we are done with the closure of the uterine incision in two layers we have to make sure we don't have any bleeding

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don't leave any bleaders

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if there are any bleeding we have to do hemostatic sutures

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in those areas where we see bleeding

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we have to make sure we are controlled

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all the bleeding sites

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you can see now there are two bleeders

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that the surgeon is going to control using hemostatic sutures

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So once we are sure the bleeding has been controlled, we don't have any other procedure like tubal ligation

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we'll just return the uterus to the abdominal cavity