ABSTRACT
When performing a vaginal hysterectomy, the operator transversely incises the vaginal epithelium and sharply dissects centrally on the cervix to incise the supracervical septum and then the vesicouterine peritoneum in order to enter the anterior cul-de-sac. Here, the dissection needs not be too lateral, as mentioned before. Care must be taken to direct the dissection superiorly, and not posteriorly into the cervix or anteriorly into the bladder. This requires a palpable “feel” for the dissection plane. Any entry into the bladder during this dissection will be 1 to 2 cm above the trigone in the center of the bladder. A two-layer closure with absorbable suture, followed by cystoscopic confirmation of bilateral ureteral function, is required, along with catheter drainage of the bladder for a week. Some surgeons also recommend a retrograde cystogram one week postop to confirm satisfactory healing before the catheter is removed from the bladder.
