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Vaginal hysterectomy, vaginal salpingoophorectomy and uterosacral ligament colpopexy: a view from above (in English and Spanish)

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Abstract

Aim of the video

The aim of this video is to make vaginal hysterectomy (TVH), vaginal salpingoophorectomy and uterosacral ligament (USL) colpopexy approachable by showing the key procedural steps from both the vaginal and abdominal perspectives.

Methods

This production shows TVH with salpingoophorectomy and USL colpopexy that was performed on a cadaver and filmed simultaneously from the vaginal and abdominal views. The video begins with an anatomy overview from the open abdomen and proceeds with the TVH. The anterior and posterior peritoneal entries, a technique to safely and easily access the adnexa, as well as the placement of USL suspension sutures are highlighted. The proximity of the ureter and its distance from the three locations most vulnerable to injury during this procedure (the uterine artery pedicle, the infundibulopelvic ligament and the USL) are illustrated. The location of the USL suspension sutures in relation to the ischial spine, the rectum and the sacrum are demonstrated. For all of these crucial steps, a series of picture-in-picture views simultaneously showing the abdominal and vaginal perspectives are presented so that the viewer may better understand the spatial anatomy.

Conclusion

This video provides the viewer with a unique anatomic perspective and helps more confidently perform TVH, vaginal salpingooophorectomy and USL colpopexy.

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References

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    Shull BL, Bachofen C, Coates KW, Kuehl TJ. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000;183(6):1365–1373.

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    Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, van Voorst S, Mol BW, Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;3:CD003677.

  3. 3.

    Moen MD, Richter HE. Vaginal hysterectomy: past, present, and future. Int Urogynecol J. 2014;25(9):1161–1165.

  4. 4.

    American College of Obstetricians and Gynecologists. Choosing the route of hysterectomy for benign disease. ACOG Committee Opinion No. 444. Obstet Gynecol. 2009;114:1156–1158.

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Author information

Correspondence to Lauren N. Siff.

Ethics declarations

Conflicts of interest

M. D. Walters: Consultant to Coloplast. The other authors have no conflicts of interest to disclose.

Consent

The procedure and video were performed on an unidentified cadaver and therefore written informed consent does not apply. This was confirmed as exempt by the Cleveland Clinic Institutional Review Board.

Electronic supplementary material

Below is the link to the electronic supplementary material.

(MP4 57839 kb)

(MP4 57821 kb)

Video S1

(MP4 57839 kb)

Video S2

(MP4 57821 kb)

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Cite this article

Siff, L.N., Jallad, K., Pizarro-Berdichevsky, J. et al. Vaginal hysterectomy, vaginal salpingoophorectomy and uterosacral ligament colpopexy: a view from above (in English and Spanish). Int Urogynecol J 28, 151–153 (2017) doi:10.1007/s00192-016-3102-9

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Keywords

  • Vaginal hysterectomy
  • Uterosacral ligament colpopexy
  • Surgical education
  • Urogynecology