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The patient was prepared and draped in the usual sterile manner for an abdominoperineal procedure. A weighted speculum was placed in the posterior vaginal vault. The cervix was grasped with a Massachusetts clamp on both its anterior and posterior lips. With downward traction, we made a circumferential incision of the vaginal mucosa. This allowed dissection and entrance into the posterior cul-de-sac. At this time we visualized the uterosacral ligaments. These were clamped and ligated with #0 Vicryl suture. The cervicovesical space was then created by both blunt and sharp dissection, allowing us to see the cardinal ligaments. These were clamped and ligated with #0 Vicryl suture as well. Once in the cervicovesical space, we were then able to completely ligate the uterosacral-cardinal ligament complex with #0 Vicryl suture. The anterior cul-de-sac was then entered sharply. Omentum and intestines were then visualized through the anterior cul-de-sac window and we began removal of the uterine body. The uterine arteries were then clamped and ligated with #0 Vicryl suture and carried upward toward the uterus until complete removal was obtained. Number 0 Vicryl suture was used on all major pedicles with Heaney clamping. The tubes and ovaries were visualized on either side. The ovarian-tubal complex was doubly ligated with #0 Vicryl suture. We then removed the weighted duckbill speculum and placed a regular speculum in the vaginal vault and visualized the entire area. We inspected for hemostasis, and this was secured. Angled sutures were placed at 3 and 9 o'clock using #0 Vicryl suture in the usual manner. Once these angled sutures were placed and tension was applied, we could see the peritoneum on either side. We closed the peritoneum with #0 Vicryl in a running continuous manner. Hemostasis was excellent. We irrigated copiously. The sponge count was correct times 2 at this time. We then began closure of the vaginal mucosa. Number 0 Vicryl suture was used to close the vaginal mucosa in a running continuous manner, starting at the 9 and 3 o'clock positions and meeting in the midline. A Foley catheter was then inserted and clear urine was obtained. The patient's procedure was terminated. We then awakened her. She was sent to the Recovery Room in good condition.

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