November 2006 · Vol. 18, No. 11Injury-free vaginal surgery: Case-based protective tactics
A strategy for avoiding, recognizing, and repairing injuries intraoperatively—and averting litigation
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Fast Track
Anterior colporrhaphy can lead to scarring between the bladder and anterior vaginal walls and raises the risk of later bladder injury
Injuries to the bladder dome and the lateral or anterior bladder neck usually heal spontaneously
If the bladder is injured during vaginal hysterectomy, repair can be deferred until the uterus and ovaries have been removed
Remove any permanent suture that is kinking a ureter, but consider leaving absorbable sutures
Most rectal injuries occur during dissection of the posterior vaginal wall
Injuries identified intraoperatively can usually be repaired by the gyn generalist using simple techniques
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Lennox
Hoyte,
MDDirector of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla
CASE 1 Gush of fluid during dissection
A 55-year-old woman with 2 prior cesarean deliveries and stage III uterovaginal prolapse (primarily apical) is now undergoing transvaginal hysterectomy and prolapse repair. During sharp dissection of the bladder off the lower uterine segment, a gush of clear fluid washes over the area of dissection.
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