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Total Vaginal Hysterectomy by Steven McCarus, MD
Authored by
Steven McCarus, MD
Authored by
Steven McCarus, MD
Total Vaginal Hysterectomy by Steven McCarus, MD
Operative Steps
Operative Steps
- A weighted speculum is placed in the posterior vagina and a curved dever is placed in the anterior vagina.
- The cervix is grasped with a Jacob tenaculum, at 12 and 6 o’clock.
- Vaso-Pitressin or saline is injected at 2-4-8-10 o’clock location of the cervix.
- Using traction, a circumferential incision is made around the cervix. This can be accomplished, with a scalpel, scissors, or electrosurgical unit handpiece.
- Once the vaginal mucosa is retracted with the surgeon's index finger, pick up the peritoneum and incise with Metzenbaum scissors anteriorly and then posteriorly.
- Clamp and cut off the uterosacral ligaments with 0 Vicryl-Plus suture with CT 1 needle. Tag the suture for later use.
- Pulling on the suture divide Cardinal ligaments as well the lower uterine segment with an advanced energy device, such as ENSEAL X1 Large Jaw
- Next, divide following structures:
- the uterine vessels.
- the uterine ovarian vessels.
- the round ligament.
- the fallopian tube.
- The uterus is extracted trans-vaginally. The tenaculums are placed on the cervix and the organ is gently pulled out of the pelvic cavity through the vagina for removal.
- Using 3-0 Vicryl plus suture purse string the peritoneum exteriorizing all pedicles.
- Grasping the anterior vaginal mucosa place your first bite with a barbed suture such as 2-0 Stratafix Knotless Tissue Control Device.
- Pulling on the previously placed 0 Vicryl-Plus 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