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

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Procedure Outline

  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