7709 Tips and Tricks for Vaginal Hysterectomy

Abstract

<h3>Study Objective</h3> The objective of this video is to review surgical techniques and tips for vaginal hysterectomy to improve provider confidence and serve as an educational tool. <h3>Design</h3> Audio narration, still images, and surgical footage will be used to review difficult scenarios and present an evidence-based approach to troubleshoot common issues. <h3>Setting</h3> Video footage was filmed with patients in dorsal lithotomy positioning in the operating room. <h3>Patients or Participants</h3> Patients with varying degrees of pelvic organ prolapse, ranging from stage 0-IV on POP-Q (Pelvic Organ Prolapse Quantification), were filmed during vaginal hysterectomy for heavy menstrual bleeding or prolapse repair. <h3>Interventions</h3> This video will review four common difficulties faced during vaginal hysterectomy: patient selection, the colpotomy, vaginal salpingectomy, and laparoscopically assisted vaginal hysterectomy. <h3>Measurements and Main Results</h3> This video discusses how to select candidates for vaginal hysterectomy including commonly misquoted contraindications. An approach, using the physical exam as guidance, is given for the anterior and posterior colpotomy and video footage is used to review how to troubleshoot the anterior entry. Steps to improve visualization for vaginal salpingectomy are discussed. Finally, laparoscopically assisted vaginal hysterectomy and how to divide the case between laparoscopic and vaginal approaches is reviewed to optimize success in the operating room. <h3>Conclusion</h3> This video reviews important steps of vaginal hysterectomy and provides tips to improve surgeon confidence. It can serve as an educational resource for trainees and early-career surgeons to improve their knowledge and confidence in performing vaginal hysterectomy. These types of resources are important to counter declining rates of vaginal hysterectomy and decreasing provider comfort in performing this operation.