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

General SurgeryObstetrics & Gynecology
Main TextProcedure OutlineTranscript

Procedure Outline

Table of Contents

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