VAGINAL HYSTERECTOMY

VAGINAL HYSTERECTOMY

Objective

•   In cases of tumor or bleeding from uterus.

•   removal of the uterus through a vaginal approach.

Position

Lithotomy.

Anesthesia

Epidural or general.

Procedure

   1.  A weighted vaginal speculum is placed in the vaginal canal.

   2.  Cervix is grasped with a tenaculum.

   3.  Dilatation and curettage may be performed.

   4.  An incision is made anterior to the cervix in the vaginal wall.

   5.  The bladder is reflected from the cervix using sharp, then blunt dissection.

   6.  Exposing the peritoneum of the anterior cul-de-sae, which is then incised, posteriorly.

   7.  Uterosacral ligaments are ligated and divided.

   8.  Uterus is placed on traction.

   9.  Uterine arteries are ligated and divided, and the uterus is delivered.

10.  The incisions into the cul-de-sac and vaginal apex are repaired.

11.  Uterosacral and round ligament stumps may be sutured to the angles of the vaginal vault closure.

12.  The vagina may be packed.

Instruments

•  General set-one                               10 (Fig. 8.51)

•  Artery forceps Spencer Wells (8 in)

•  Deep retractors (Deavor)                 2

•  Artery forceps (8 in) (Kocher)          6 (Fig. 8.55)

•  Vulsellum (Teale)                             2 (Fig. 10.30)

•  Scissors heavy curved (8 in) Mayo   1 (Fig. 8.32)

•  Auvards vaginal speculum (Fig. 10.33).

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