In the majority of instances, no preoperative douches are used. The symphysis, perineum, and adjacent surfaces are not shaved but may be clipped carefully before operation. A preoperative cleansing enema is optional. Prophylactic antibiotics are administered.
General or regional anesthesia is satisfactory.
Vaginal procedures are carried out in the lithotomy position. After induction of anesthesia, the patient’s buttocks are brought to the edge of the table. The legs are raised simultaneously to avoid straining the sacroiliac joints and are fixed in stirrups with the knees flexed. Whenever possible, the legs are elevated upward and backward to permit the assistant to be nearer the field of operation. Excessive hip flexion, abduction, and external rotation should be avoided. The operating table is turned so that the light falls on the field and is focused on the introitus.
The vulva and adjacent skin areas are scrubbed from above downward with pairs of prepping sponges held in gloved hands. The sponges are saturated with water and prep solution. In all, approximately five pairs of sponges are used, each being discarded as it comes in contact with the anus. The vaginal vault is cleaned with approximately five saturated sponges that are attached to a prepping stick. Dry sponges are used to remove excess solution from the vaginal vault, and the cleaned skin is blotted dry with a sterile towel. The anus may be excluded from the operative area by the use of a spray-on adhesive compound and application of a piece of sterile, transparent plastic film. The footboard of the operating table can be raised to a convenient level and serves as an instrument table for the surgeon. A sterile, fenestrated perineal drape is applied, and the bladder is emptied by catheterization. Then a time-out is performed.
Adequate exposure is obtained by introducing into the vagina either a weighted vaginal speculum, handheld retractors, or a self-retaining retractor depending on the type and location of the operation to follow. A thorough pelvic examination is made as a preliminary to the technical procedure.
After completion of the operation, the vagina and perineum are cleaned with sponges moistened with saline or a mild antiseptic solution. A sterile perineal pad is then applied and held in position by a T-binder. When constant bladder drainage is desired, a Foley catheter is inserted and held by adhesive tape anchored to the thigh. The drapes are removed, and the legs are withdrawn slowly and simultaneously from the stirrups to prevent disturbances in blood pressure and straining of the sacroiliac joints.
Immediate postoperative care is similar to that following abdominal procedures, with certain added perineal precautions. Indwelling catheters are not necessary. The patient ...