Hysterectomy is one of the most common major surgeries in gynecology. This episode reviews the different surgical approaches, the decision to take or leave the tubes and ovaries, the critical surgical steps – including the four sites of ureteral injury – and key anatomy like the IP ligament, uterine artery, and round ligament.

Show Outline:

Approach – Abdominal, laparoscopic, vaginal, or combination
Tubes and Ovaries – What benefit do they provide? Ovaries still benefit bones and cardiovascular health even after menopause (65yr old cut-off for removal).
Key Surgical Steps
1. Round Ligament – Sampson's artery runs inside
2. IP Ligament (formerly suspensory ligament of the ovary) – Conceals ovarian blood supply from the aorta. If transected before fully sealed, can hemorrhage while retracting into the retroperitoneum.
3. Four Levels of Ureteral Injury – (1) Pelvic brim, (2) medial to IP ligament, (3) under the uterine artery (“water under the bridge”), (4) lateral to vaginal cuff closure
4. Uterine Arteries – Ligate and transect; the uterus should blanch white
5. Colpotomy – Disconnecting the uterus from the vagina
6. Vaginal Cuff Closure – If total hysterectomy

About the Speaker:

Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators.

Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

Before Your First: Hysterectomy

Procedure Ready: Ob/Gyn