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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

Article type:Descriptions of Clinical and Surgical Procedures

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

176190 views

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

Obstetrics & Gynecology

Manuscript Format: Full Text

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. Introduction

                            2. Surgical Approach

                            1. Expose Cervix
                            2. Inject Local Anesthetic

                            3. Gain Peritoneal Access

                            1. Circumferential Incision Around Cervix
                            2. Gain Peritoneal Access Posteriorly, Protecting Rectum
                            3. Gain Peritoneal Access Anteriorly, Protecting Bladder

                            4. Hysterectomy

                            1. Divide along Broad Ligament
                            2. Divide Utero-Ovarian Ligament

                            5. Isolate and Tag Uterosacral Ligaments

                            6. Cystoscopy

                            7. Anterior Repair

                            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

                            8. Closure for Anterior Repair and Vaginal Cuff Closure

                            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

                            9. Repeat Cystoscopy

                            10. Cut Uterosacral Ligament Stitches

                            11. Perineorrhaphy

                            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

                            12. Rectal Exam

                            13. Post-op Remarks

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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