Stop the Bleed: A Video Demonstration of Surgical Techniques to Ensure Hemostasis and Manage Bleeding During a Vaginal Hysterectomy

INTRODUCTION: The American College of Obstetricians & Gynecologists currently recommends the use of a vaginal hysterectomy when feasible for hysterectomies with benign indications. Despite this recommendation, vaginal hysterectomy rates have been decreasing. This is in part attributed to increasing laparoscopic rates, decreasing trainee exposure, and provider discomfort. A major challenge to the vaginal approach is the difficulty in ensuring hemostasis and controlling bleeding. OBJECTIVE: This video aims to provide a surgical technique to control bleeding during vaginal hysterectomies performed using a vessel-sealing device. This will be done via the demonstration of the use of a whip stitch to achieve hemostasis of the uterine vessels in conjunction with the use of a Shallcross clamp for identifying and isolating a bleeding vessel. METHODS: The surgical footage from two vaginal hysterectomies was captured, one demonstrating a whip stitch and the other demonstrating the use of a Shallcross clamp to identify and ligate bleeding vessels. RESULTS: Improved hemostasis has been observed when placing a whip stitch along the cardinal ligament to the vaginal cuff and using a Shallcross clam to identify and ligate bleeding vessels. CONCLUSIONS: This video demonstrates 1) the use of a whip stitch along the cardinal ligament to prevent hematoma and seroma formation and 2) vessel identification and ligation using a Shallcross clamp to control bleeding during a vaginal hysterectomy. This was done with the goal of providing surgeons with new surgical techniques and increasing provider comfort with the vaginal hysterectomy.