With some technical modifications in the traditionally taught steps of the vaginal hysterectomies,we can make the procedure simpler and faster.
1) One can use hydrodissection technique as described in the previous blog
2) Dont go after opening the anterior fold of peritoneum,just retract the bladder under some retracter and go on applying the clamps. The A pouch will open up on its own after we take the uterines ,except in cases of previous LSCS where I prefer opening the pouch after ligating the uterines.
3) I dont cut the lateral vaginal wall but retain its attachment with the uterosacrals,so that the part of the vault retains its natural attachment with the ligament.
4) I anchor the uterosacrals to the vault right in the beginning by taking the long end of the suture through the posterior edge of the vagina.
5) Always take an additional pedicle of the round ligament with the ascending branch of the uterine. This simplifies the approach to the infundibulopelvic ligament and takes care of the chances of bleeding in the post op period.
5) One should use the morcellation technique i.e bisection,transection,coring ,to debulk the uterus for easy delivery
6) Vaginal Myoma screw is a very handy instrument to apply traction to deliver a fibroid or a uterus
7) Always secure the vaginal angles securely as they the most notorious oozers in the post op period.
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