For supravaginal hysterectomy, the operation proceeds as in total abdominal hysterectomy except that the uterine arteries may be ligated higher on the cervix. Technically, this is an easier and safer operation to perform, as the uterine artery suture ligatures are placed further away from the ureters. It requires, however, that the patient be compliant with lifelong gynecologic examinations that include cervical Pap tests. The cervix is kept in position by Teale or similar forceps at the lateral margins and is divided at the level of the internal os, or lower (Figure 4). The cervical canal must be coned out completely from above for microscopic examination. The procedure also serves as prophylaxis against the eventual development of carcinoma in the retained cervical stump. The cervical stump then is closed transversely by placing with a cervix-cutting needle several figure-of-eight sutures of 0 absorbable suture, one in each lateral angle and one or more in the central portion. These sutures must be placed sufficiently deep to secure complete hemostasis.