Vaginal hysterectomy steps

The uterus is a very important reproductive organ for women, but in some special cases, the uterus needs to be removed, such as urinary incontinence, severe infection, uterine cancer, ovarian cancer, etc. Hysterectomy can be performed partially or completely depending on the specific situation, and vaginal hysterectomy is a typical method of the latter. So, what are the steps for vaginal hysterectomy? Let’s take a look below.

a. Body position: bladder lithotomy position, routine disinfection of perineum and vagina, and fix the labia minora on both sides to the outer skin of the labia majora with silk thread.

b. Catheterization: Use a metal catheter to catheterize and understand the attachment site of the bladder to the cervix.

c. Injection of drugs: Use silk thread to fix the labia minora to the vulva skin. The cervical clamp clamps the uterus and pulls it outward and downward. Inject sterile saline solution under the mucosa of the anterior and posterior walls of the vagina, or add an appropriate amount of epinephrine (5 to 6 drops in 100 saline solution) to reduce bleeding and facilitate separation. For patients without bladder or rectal prolapse, there is no need to inject medicine under the vaginal mucosa.

d. Resection of the anterior vaginal wall mucosa: Make a triangular incision on the anterior vaginal wall, deep under the vaginal mucosa, and peel off the vaginal mucosa from the tip of the triangle to expose the pubic vesicocervical fascia. Patients without cystocele can skip this step. Free the bladder, starting from the vesicocervical gap, use scissors to separate the tissue of the bladder attached to the cervix, and push the bladder upward with your fingers until it reaches the fold of the bladder and uterine peritoneum.

e. Circumcision and separation of the lateral and posterior cervical mucosa: Pull the cervix forward, make incisions along both sides of the cervix, extend toward the posterior wall, until the entire cervix is ​​circularly incised, and use the knife handle or fingers to separate the lateral and posterior vaginal mucosa to expose the uterosacral ligament.

f. Cutting and suturing the uterosacral ligament: Clamp and cut with a vascular clamp, suture with No. 7 silk thread, and keep the silk thread as a mark.

g. Cutting and suturing the cardinal ligament: Pull the cervix downward and to the opposite side, clamp the cervix tightly with a vascular clamp, cut and suture the cardinal ligament with No. 7 silk thread. If the cervical canal is long, it can be treated in several times.

h. Handle the uterine blood vessels: Pull the cervix downward and to the opposite side, clamp the cervix tightly with a vascular clamp, cut it, and suture the uterine blood vessels with No. 7 silk thread. Handle the contralateral main ligament and uterine blood vessels in the same way.

i. Incise the bladder and uterine reflected peritoneum: lift up the bladder reflected peritoneum, make a small cut after confirming that it is correct, and then expand the incision to both sides. Silk thread can be sutured at the midpoint of the peritoneum for traction as a mark.

g. Incise the uterine and rectal reflected peritoneum: lift up the bladder and rectal reflected peritoneum, make a small cut after confirming that it is correct, and then expand the incision. Silk thread can also be used for traction and marking.

k. Handling of the appendages: Pull the uterine body outward from the incision of the rectouterine pouch (if it is an anterior uterus, it can also be pulled out from the peritoneal incision of the uterine bladder reflection). If the appendages are to be retained, use two vascular clamps to clamp the isthmus of the fallopian tube, the proper ovarian ligament and the round ligament at the uterine horn, cut them off and suture them twice with No. 7 silk thread, leaving a thread at the proximal end as a mark. Treat the contralateral side in the same way. If the appendages need to be removed, the uterine body should be pulled out more to expose the pelvic infundibulum ligament, which should then be clamped, cut, and double-sutured.

l. Suture the pelvic peritoneum: lift the anterior and posterior edges of the peritoneum, check that there is no bleeding on the wound, and use No. 4 silk thread to start from the anterior peritoneal edge on one side, through the round ligament and the peritoneum on the inner side of the accessory suture, and then through the posterior peritoneum and tie a knot. The contralateral angle was treated in the same way, and then the peritoneum was sutured continuously and the pelvic cavity was closed. This places the uterine appendages and the ends of the ligaments outside the peritoneum.

m. Suture each ligament accordingly: ligate the retained thread of each ligament to the ligament of the same name on the opposite side, and cut off the ligature. Use O-size synthetic suture to penetrate the posterior vaginal mucosa, sew around the broken ends of the ligaments, and then penetrate out from the posterior vaginal mucosa and ligate it to rebuild the pelvic floor support, strengthen the pelvic floor support, and suspend the vaginal stump. If the distance between the two sides is far. No suturing is necessary.

n. Suturing the vaginal mucosa: Starting from the urethral opening, use No. 0 synthetic thread to suture the vaginal mucosa intermittently, and when it approaches the edge, change to front and back suture