Task Analysis for Uterosacral Ligament Vault Suspension after Hysterectomy
Dr. Adrián Castro M.
1. Patient clerkship and physical examination.
2. Informed consent from patient.
3. Check if any extra medical considerations regarding patient’s anamnesis are required
4. Surgical safety checklist
1. Prophylactic antibiotics on induction
2. General anaesthesia
3. Patient in Trendelenburg position
4. Abdominal shaving
5. Speculum exam
6. Physical examination if not performed earlier
7. Monitors in position 15 to surgeon’s eye axis surgeon on left assistant on the right
8. Second assistant between the legs,
9. Ensure all cables in order
- Entry technique as preferred by surgeon and clinical history of patient
- Ports placement: laparoscope is ideally at umbilicus, accessory ports are placed at least 7.5 cm from central trocar lateral to umbilicus. Trocar size 5 mm
- Eye instrument axis must be maintained. the target is the vaginal vault
- General endotracheal anesthesia has already been induced.
- Abdomen has already been insufflated with CO2 (see previous section)
- Careful pelvic and upper and lower abdomen exam is performed
- Patient should be placed in Trendelenburg position
- Bowel is swept out of the pelvis if needed
- Using a rectal sizer placed in the vaginal vault, the vault is inverted
- Peritoneal lining should be identified overlying the pubocervical and rectovaginal fascias
- Uterosacral ligaments should be indentified as well as their topographic relation to the urethers (the latter run anterolateral to the ligaments) in order to avoid lesions at this level)
- Follow the uterosacral ligaments as they enter the sacrum
- Tag with suture the unbroken uterosacral ligament bilaterally
- Open the peritoneum overlying the pubocervical and rectovaginal fasciae
- By sharp dissection, identify ventrally the pubocervical fascia that lies between the vagina and the bladder
- Identify posteriorly the rectovaginal fascia
- Excise redundant peritoneum and excess vagina as needed
- Take stitches at the corners on each side in a way they will approximate the edges of the pubocervical to the rectovaginal fascia overlying the vaginal mucosa
- The corner stitch on each side is then incorporated into the ipsilateral uterosacral ligament which had been already tagged
- The now reapproximated fasciae along with the vaginal apex are now incorporated to the uterosacral ligaments as the enter the sacrum on both sides
- The pubocervical and rectovaginal fascia are hence sutured to the unbroken uterosacral ligaments
- The pubocervical fascia is approximated to the rectovaginal fascia acrros the center of the vaginal vault with interrupted sutures
- Reinforcing sutures from the uterosacral ligaments to the posterior rectovaginal fascia are then placed bilaterally, taken into the account not to cross the midline but rather reinforce the attachment of the corner of the vaginal vault to the ipsilateral uterosacral complex
- Cystoscopy should be ideally performed to rule out kinking of the urethers during the suspension of the uterosacral ligaments to the vaginal vault
- Hemostasia is confirmed
- Ports are withdrawn under direct visualization, optical port is withdrawn and closed
- Deinsufflation of abdomen is done
- Skin incisions are sutured
Dr. Sunita Rani
May 23rd, 2020 9:57 am
You're so Awesome sir .. so clear so easy .. you have a great quality of teaching sir. Dr. Mishra is so sweet that I prefer to watch his videos of Laparoscopy surgery's much more than watching any other lectures. Thanks for posting this Task Analysis for Uterosacral Ligament Vault Suspension after Hysterectomy.
May 23rd, 2020 10:04 am
You are awesome sir. You will occupy a unique position in the history of modern teaching in the field of Laparoscopy Surgery Thanks for posting this Task Analysis for Uterosacral Ligament Vault Suspension after Hysterectomy.
Areen D Wanrio
May 23rd, 2020 10:09 am
Simple definition and step of Task Analysis for Uterosacral Ligament Vault Suspension after Hysterectomy surgery's. Really great provide point to point exact information. Thanks for posting this.
Dr. Neha kumari
May 23rd, 2020 11:01 am
This Article really helps me a lot, thank you! Your explanation is so clear and very impressive well presented Task Analysis for Uterosacral Ligament Vault Suspension after Hysterectomy.
May 23rd, 2020 11:07 am
Thank you !!! keep up the good work you’re the real Inspiration for Laparoscopic Surgeon all over the world!!! Thanks for posting this Task Analysis for Uterosacral Ligament Vault Suspension after Hysterectomy.
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