Uterine sarcomas are soft tissue malignancies that make up less than 5% of all uterine tumors. Because of their highly aggressive nature and potential to metastasize, surgical resection is the primary treatment. A total hysterectomy and bilateral salpingo-oophorectomy is considered to be the “Gold Standard”. After the patient is prepped and draped in sterile fashion, a midline incision is made. The fascia, subcutaneous tissue and muscle layer is dissected in order to reach the abdominopelvic cavity. A Bovie is used to cauterize any bleeding vessels. Any bleeding vessels must be cauterized or tied off with suture in order to minimize excessive blood loss. Once the uterus and tumor are visualized, the entire specimen must be carefully dissected away from the surrounding tissue and organs. This is done to minimize the risk of accidentally spreading the cancer cells throughout the abdominopelvic cavity. The uterus and tumor specimen are then isolated with clamps as the surgeon continues to dissect it free from adjacent tissues. If the tumor has spread beyond the primary reproductive organs, it may be necessary to completely or partially resect any neighboring organs that are affected. This is known as surgical “debulking”, and is performed in an effort to remove as much of the cancer as possible, hopefully improving patient prognosis. Once it has been completely dissected, the entire unit (which consists of the uterus, tumor, ovaries and fallopian tubes), is carefully removed and placed in a sterile container that contains formalin. After the specimen has been properly labeled with the patient’s identifying data, it is sent to pathology for cytologic and histologic evaluation. Additional staging procedures may include lymph node sampling, not shown here. Pathologic evaluation of the specimen is the only reliable way to stage the cancer. Upon closing, the abdominal muscles and subcutaneous layer are then sutured closed. In this case, the skin was approximated using surgical staples and then sterile dressing was applied to the wound.

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