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Title
1. Introduction
2. Surgical Approach
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a. Expose Cervix
b. Inject Local Anesthetic
3. Gain Peritoneal Access
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a. Circumferential Incision Around Cervix
b. Gain Peritoneal Access Posteriorly, Protecting Rectum
c. Gain Peritoneal Access Anteriorly, Protecting Bladder
4. Hysterectomy
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a. Divide Along Broad Ligament
b. Divide Utero-Ovarian Ligament
5. Isolate and Tag Uterosacral Ligaments
6. Cystoscopy
7. Anterior Repair
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a. Expose Anterior Wall
b. Inject Local Anesthetic
c. Incision
d. Dissection to Isolate Cystocele
e. Reduce Bulge
f. Review Repair
g. Excise Redundant Tissue
8. Closure for Anterior Repair and Vaginal Cuff Closure
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a. Anterior Repair Closure
b. Place Uterosacral Ligament Stitches Through Vaginal Cuff
c. Finish Closure of Anterior Wall and Vaginal Cuff
d. Tie Down Apical Suspension Sutures
9. Repeat Cystoscopy
10. Cut Uterosacral Ligament Stitches
11. Perineorrhaphy
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a. Expose Posterior Wall and Examine Defect
b. Inject Local Anesthetic
c. Diamond-Shaped Incision
d. Excise Epithelium
e. Tag Apex
f. Rebuild Perineal Body
12. Rectal Exam
13. Post-op Remarks
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Vaginal Hysterectomy, Uterosacral Ligament Suspension, Anterior Repair, and Perineorrhaphy
Emily C. Von Bargen, DO
;
Patricia L. Hudson, MD
;
Lori R. Berkowitz, MD
Massachusetts General Hospital
Tags:
Obstetrics & Gynecology
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Authors
Emily C. Von Bargen, DO
Patricia L. Hudson, MD
Lori R. Berkowitz, MD
Filmed At:
Massachusetts General Hospital
Article Information
Publication Date
5/4/2023
Article ID
267
Production ID
0267
Volume
2023
Issue
267
DOI
https://doi.org/10.24296/jomi/267