Total Abdominal Hysterectomy by Steven McCarus, MD

Operative Steps

A Foley catheter is placed.
Abdominal wall incision is made, layers of the abdomen are identified and opened, and after the incision is made self-retaining retractors are placed.

The mesosalpinx (if the ovary is retained) or infundibulopelvic ligament (if the ovary is being removed) is clamped coagulated and cut.

With successive clamping, coagulating, and cutting, the dissection continues down the broad ligament to the uterine vessels.

The anterior bladder peritoneum is incised with scissors and the bladder is pushed down with the sponge stick forceps. Broad ligament is pushed forward with the surgeons’ fingers.

Using Enseal X1 Large Jaw the Uterine vessels are divided. 0-Vircyl plus suture with CT-1 needle to cut out the vessels can be used.

Placing right angle hysterectomy clamps, the cervical vaginal junction is incised and the uterus and cervix are removed.

Grasping the anterior vaginal mucosa place your first bite with a barbed suture such as 2-0 Stratifix Knotless Tissue Control Device.
Place Suture on the uterosacral ligament incorporate this as your second closure bite.
Suture the posterior angle to complete the angle closure (Only the angles have three bites for closure).
Run the suture anteriorly to posteriorly, making sure full-thickness bites are taken, to the opposite angle.
Lastly, complete the angle in a similar manner as previously mentioned (3 bites).
Back track the suture one or two bites then cut the remaining suture.

Note: Vaginal cuff can be closed using 0-Vicryl Plus suture in a continuous or interrupted technique.

2 x size 0 Stratafix Symmetric Knotless Tissue Control Device is used to approximate the fascial layer.