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  • Title
  • 1. Introduction
  • 2. Surgical Approach
  • 3. Gain Peritoneal Access
  • 4. Hysterectomy
  • 5. Isolate and Tag Uterosacral Ligaments
  • 6. Cystoscopy
  • 7. Anterior Repair
  • 8. Closure for Anterior Repair and Vaginal Cuff Closure
  • 9. Repeat Cystoscopy
  • 10. Cut Uterosacral Ligament Stitches
  • 11. Perineorrhaphy
  • 12. Rectal Exam
  • 13. Post-op Remarks

Vaginal Hysterectomy, Uterosacral Ligament Suspension, Anterior Repair, and Perineorrhaphy

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Emily C. Von Bargen, DO; Patricia L. Hudson, MD; Lori R. Berkowitz, MD
Massachusetts General Hospital

General SurgeryObstetrics & Gynecology

Procedure Outline

Table of Contents

  1. 1. Introduction
    1. 2. Surgical Approach
      1. 3. Gain Peritoneal Access
        1. 4. Hysterectomy
          1. 5. Isolate and Tag Uterosacral Ligaments
            1. 6. Cystoscopy
              1. 7. Anterior Repair
                1. 8. Closure for Anterior Repair and Vaginal Cuff Closure
                  1. 9. Repeat Cystoscopy
                    1. 10. Cut Uterosacral Ligament Stitches
                      1. 11. Perineorrhaphy
                        1. 12. Rectal Exam
                          1. 13. Post-op Remarks
                            1. Expose Cervix
                            2. Inject Local Anesthetic
                            1. Circumferential Incision Around Cervix
                            2. Gain Peritoneal Access Posteriorly, Protecting Rectum
                            3. Gain Peritoneal Access Anteriorly, Protecting Bladder
                            1. Divide along Broad Ligament
                            2. Divide Utero-Ovarian Ligament
                            1. Expose Anterior Wall
                            2. Inject Local Anesthetic
                            3. Incision
                            4. Dissection to Isolate Cystocele
                            5. Reduce Bulge
                            6. Review Repair
                            7. Excise Redundant Tissue
                            1. Anterior Repair Closure
                            2. Place Uterosacral Ligament Stitches Through Vaginal Cuff
                            3. Finish Closure of Anterior Wall and Vaginal Cuff
                            4. Tie Down Apical Suspension Sutures
                            1. Expose Posterior Wall and Examine Defect
                            2. Inject Local Anesthetic
                            3. Diamond-Shaped Incision
                            4. Excise Epithelium
                            5. Tag Apex
                            6. Rebuild Perineal Body

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                            Authors

                            Filmed At:

                            Massachusetts General Hospital

                            Article Information

                            Publication Date
                            Article ID267
                            Production ID0267
                            Volume2023
                            Issue267
                            DOI
                            https://doi.org/10.24296/jomi/267