Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH-BSO) Guidelines

Preoperative Considerations

The American College of Surgeons recommends appropriate bowel preparation, especially if there's potential for bowel resection, for patients undergoing TAH-BSO 1
Patients should be positioned for optimal exposure with preparation for a vertical midline abdominal approach 1

The surgical approach involves making a paramedian incision to access the abdominal cavity, followed by thorough exploration of the entire abdominal cavity to assess disease extent 1
Inspection and palpation of abdominal organs, including liver, diaphragm, omentum, and peritoneal surfaces, should be performed 2, 3
Peritoneal washings for cytology should be obtained 2, 3
Complete excision of the lumbar-ovarian vessels bilaterally, ligation and division of the round ligaments bilaterally, and identification, ligation, and division of the uterine vessels should be performed 1
Total hysterectomy with complete removal of the uterus and cervix, as well as removal of fallopian tubes and ovaries bilaterally, should be performed 2, 3

For gynecologic malignancies, the standard treatment is TAH-BSO with appropriate surgical staging, according to the National Comprehensive Cancer Network 2, 3
Lymphadenectomy may be performed based on disease indication, though its routine use in early endometrial cancer remains controversial 2, 3
Abdominal organs should be carefully inspected and palpated during the procedure for endometrial cancer 2, 3
In cases of cervical involvement, radical hysterectomy with BSO may be preferred 2, 3

The operative report must include precise details of findings and procedures performed, according to the American College of Surgeons 1
Documentation should specify any pathological findings, quality of excision margins, and completeness of the procedure 1