LAVH_BSO

DATE OF SURGERY: 05/23/2026 11:09 PM
PRE-OP DIAGNOSIS: Leiomyoma Uteri
POST-OP DIAGNOSIS: Leiomyoma Uteri
PROCEDURE: Laparoscopic Assisted Vaginal Hysterectomy
EBL: Minimal
SPECIMENS: Uterus, Fallopian Tubes
CONDITION: excellent

Description of procedure

The patient was brought to the operating room and general endotracheal was initiated. The patient was then prepped and draped in the usual sterile fashion in the dorsal lithotomy position with Allen stirrups. The time out safety protocol was called out by the surgeon and affirmed by all personnel present. A uterine manipulator was then placed in the uterus without difficulty. The surgeon then removed over gloves, and moved to the abdomen. A 5mm umbilical incision was made, and the verres needle was used to create a pneumoperitoneum. A 5mm trocar was then placed without difficulty. The camera was then introduced, and the pelvis was inspected with the findings as described above. The patient was placed in Trendelenburg. A 5mm suprapubic port and left lateral port were then placed under direct visualization without difficulty. Both adnexa were visualized and noted to appear normal. The left adnexa was then elevated with an atraumatic grasper. The ureter was visualized transperitoneally and noted to be peristaltic and well away. The harmonic scalpel was then used to coagulate and cut the utero-ovarian ligament. The Broad ligament and the round ligament where taken down using the harmonic scalpel up to but not through the uterine vessels. Good hemostasis was ensured. The same was performed on the apposing side without difficulty. The laparoscope was then removed, and the surgeon moved to perform the vaginal part of the surgery. The legs were elevated using the Allen stirrups and the patient was brought out of Trendelenburg. Two Lahey tenaculum were placed on the cervix. The cervix was then injected circumferentially with xylocaine/epinephrine for hemostasis and to develop the planes. A circumferential cervical incision was then made. The bladder flap was developed with a ray-tech sponge. The posterior colpotomy was then made without difficulty. A central stay suture was placed to retain the peritoneum and for hemostasis. The uterosacral, cardinal, and broad ligaments were then taken down in a step wise fashion using 0-Vicryl pop-off sutures. The bladder flap was dissected cephalad during this procedure, and the anterior colpotomy was then made without difficulty. The anterior retractor was then repositioned into the peritoneal cavity. After removing the remaining broad ligament, the uterus was removed and sent to pathology. 2-Vicryl on a UR needle was used to perform a culdoplasty and a purse string closure of the peritoneum. Two Alice clamps were used to grasp the anterior vaginal mucosa. Central injection with xylocaine and epinephrine was then performed. Strully scissors were used to create central incision, and dissect the vaginal mucosa away from the underlying tissue. Pratt clamps were used on the vaginal mucosa. The underlying tissue was then imbricated using interrupted 2-0 Vicryl. The excess vaginal mucosa was trimmed and sent to pathology. The mucosa was then reapproximated with a running locking stitch. Two alice clamps were used to grasp the posterior vaginal mucosa on each opposing side. Central injection with xylocaine and epinephrine was then performed. Strully scissors were used to create central incision, and dissect the vaginal mucosa away from the underlying tissue. Pratt clamps were used on the vaginal mucosa. The underlying tissue was then imbricated using interrupted 2-0 Vicryl, including plication of the levators. The excess vaginal mucosa was trimmed and sent to pathology. The mucosa was then reapproximated with a running locking stitch. Normal vaginal caliber and length were confirmed. Two allice clamps were used to grasp the posterior vaginal mucosa on each opposing side. A central injection with xylocaine and epinephrine was then performed. Strully scissors were used to create a central incision, and dissect the vaginal mucosa away from the underlying tissue. Lateral vaginal wall retractors were used to aid in exposing the sacro spinous ligament. The Capio suture passer was then used to place a 0-prolene suture in the ligament. The other end was sutured to the vaginal apex, and the tied down, elevating the vaginal apex. Good hemostasis was confirmed. Any excess vaginal mucosa was trimmed and sent to pathology. The mucosa was then reapproximated with a running locking stitch. Normal vaginal caliber and length were confirmed The vaginal cuff was then reapproximated using running locking 0-Vicryl from either end to the middle. Two allice clamps were used to grasp the para urethral tissue, and the sub-urethral tissue was incised with a scalpel. The lateral urethral space was the exposed with blunt and sharp dissection. A trans urethral stent was placed in a foley catheter, and placed in the urethra for lateral deflection to reduce the chance of injury during trocar placement. The vaginal tape and trocars where assembled and prepared for placement. The trocar was then placed lateral to the urethra, and a stab incision on the mons pubis allowed passage of the trocar. The same was performed on the other side without difficulty. Cystocopy was then performed to insure the bladder was intact. The trocars was then removed, leaving the tape under the urethra in a tension free position. The positioning was aided using the mayo scissors as a spacer under the urethra. The excess tape was trimmed on the mons. The skin incisions where reapproximated with 4-0 Vicryl and or steri strips. The vaginal mucosa was reapproximated using 2-0 Vicryl, and a foley catheter was anchored. Good urethral support was confirmed. Gloves were then changed, and the surgeon moved back to the laparoscope. The pneumoperitoneum was re-created, and the pelvis was inspected with all pedicles noted to be hemostatic. Again, the ureters were visualized transperitoneally and noted to be peristaltic and well away from the surgical sites. The instruments were then removed, then pneumoperitoneum was evacuated, and the instrument count was correct times two. The patient was then brought out of anesthesia and transferred to the recovery room in excellent condition.

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