• 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