1
99:59:59,999 --> 99:59:59,999
Now we are going to close the uterine incision

2
99:59:59,999 --> 99:59:59,999
The uterine incision, the first thing would be to identify the angle

3
99:59:59,999 --> 99:59:59,999
because that's where the most risk of bleeding occurs

4
99:59:59,999 --> 99:59:59,999
so we should be sure that we have identified and start our sutering from the angle of the uterine incision

5
99:59:59,999 --> 99:59:59,999
and we are going to use usually vciril or chromic cat gut can also be use

6
99:59:59,999 --> 99:59:59,999
the stitch is going to be continuous

7
99:59:59,999 --> 99:59:59,999
suturing, after we grasp, make sure we have got the angle we'll go by doing continuous suturing

8
99:59:59,999 --> 99:59:59,999
and sometimes if we are doing, if we are having heavy bleeding, we can use locking sutures

9
99:59:59,999 --> 99:59:59,999
but if we feel the bleeding is controlled we don't have to lock the sutures

10
99:59:59,999 --> 99:59:59,999
while the surgeon is doing this continuous suturing, the assistant's role is a big role here

11
99:59:59,999 --> 99:59:59,999
holding the uterus still, preferably by

12
99:59:59,999 --> 99:59:59,999
using a pack

13
99:59:59,999 --> 99:59:59,999
and also holding the suture also

14
99:59:59,999 --> 99:59:59,999
by following the surgeon and hold the suture tight

15
99:59:59,999 --> 99:59:59,999
and once we have done

16
99:59:59,999 --> 99:59:59,999
in this video, you'll see that the surgeon is going to close the uterine incision

17
99:59:59,999 --> 99:59:59,999
in one layer

18
99:59:59,999 --> 99:59:59,999
and now there are two schools of thoughts about the uterine closure

19
99:59:59,999 --> 99:59:59,999
either it could be closed in one layer or two layers

20
99:59:59,999 --> 99:59:59,999
some studies have shown that using one layer closure decreases operation time

21
99:59:59,999 --> 99:59:59,999
with still the same kind of results

22
99:59:59,999 --> 99:59:59,999
still some would argue that the risk of bleeding and risk of future infection

23
99:59:59,999 --> 99:59:59,999
and disheasance would increase with one layer

24
99:59:59,999 --> 99:59:59,999
both ways are acceptable

25
99:59:59,999 --> 99:59:59,999
but usually in our practice, in our set up what we practice is using two layer approach

26
99:59:59,999 --> 99:59:59,999
so we are finish putting suture with one layer, then we are repeat the same procedure and close uterine incision in two layers

27
99:59:59,999 --> 99:59:59,999
and nowadays, we have abundant closing peritonium, even after the

28
99:59:59,999 --> 99:59:59,999
this is because it heals by iteslf quickly

29
99:59:59,999 --> 99:59:59,999
and so by not closing it it decreases postoperative pain and so it is preferred to not close the xxx

30
99:59:59,999 --> 99:59:59,999
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

31
99:59:59,999 --> 99:59:59,999
don't leave any bleaders

32
99:59:59,999 --> 99:59:59,999
if there are any bleeding we have to do hemostatic sutures

33
99:59:59,999 --> 99:59:59,999
in those areas where we see bleeding

34
99:59:59,999 --> 99:59:59,999
we have to make sure we are controlled

35
99:59:59,999 --> 99:59:59,999
all the bleeding sites

36
99:59:59,999 --> 99:59:59,999
you can see now there are two bleeders

37
99:59:59,999 --> 99:59:59,999
that the surgeon is going to control using hemostatic sutures

38
99:59:59,999 --> 99:59:59,999
So once we are sure the bleeding has been controlled, we don't have any other procedure like tubal ligation

39
99:59:59,999 --> 99:59:59,999
we'll just return the uterus to the abdominal cavity