Now we are going to close the uterine incision
The uterine incision, the first thing would be to identify the angle
because that's where the most risk of bleeding occurs
so we should be sure that we have identified and start our sutering from the angle of the uterine incision
and we are going to use usually vciril or chromic cat gut can also be use
the stitch is going to be continuous
suturing, after we grasp, make sure we have got the angle we'll go by doing continuous suturing
and sometimes if we are doing, if we are having heavy bleeding, we can use locking sutures
but if we feel the bleeding is controlled we don't have to lock the sutures
while the surgeon is doing this continuous suturing, the assistant's role is a big role here
holding the uterus still, preferably by
using a pack
and also holding the suture also
by following the surgeon and hold the suture tight
and once we have done
in this video, you'll see that the surgeon is going to close the uterine incision
in one layer
and now there are two schools of thoughts about the uterine closure
either it could be closed in one layer or two layers
some studies have shown that using one layer closure decreases operation time
with still the same kind of results
still some would argue that the risk of bleeding and risk of future infection
and disheasance would increase with one layer
both ways are acceptable
but usually in our practice, in our set up what we practice is using two layer approach
so we are finish putting suture with one layer, then we are repeat the same procedure and close uterine incision in two layers
and nowadays, we have abundant closing peritonium, even after the
this is because it heals by iteslf quickly
and so by not closing it it decreases postoperative pain and so it is preferred to not close the xxx
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
don't leave any bleaders
if there are any bleeding we have to do hemostatic sutures
in those areas where we see bleeding
we have to make sure we are controlled
all the bleeding sites
you can see now there are two bleeders
that the surgeon is going to control using hemostatic sutures
So once we are sure the bleeding has been controlled, we don't have any other procedure like tubal ligation
we'll just return the uterus to the abdominal cavity