Design: N/A

Setting:

Extended lithotomy, uterine manipulator

Patients or Participants:

Patients aged 35 to 42yrs who have been advised hysterectomy , are non responsive to medical management and Levonorgesteral implant but want Ovarian conservation

Interventions:

The procedure involves sparing half to one cm of margins of the myometrium from the level of internal os upto the ovarian pedicles keeping lateral and parallel to the ascending branch of uterine artery.

The procedure starts with identifying the ascending branch of uterine artery both sidelong with the demarcation of level of internal Os with aid of cervical cup of uterine manipulator.

Ultracision is used to create a line of margin of half to one cm of blanched myometrium from ascending branch of uterine artery , bilateral cornual ends and the isthmus going to the level of internal os both anteriorly and posteriorly.

Using the ultracision blade the margins are deepened anteriorly and posteriorly with traction and counter traction from uterine manipulator, tooth grasper and 10mm tenaculum till the internal Os is visualized.

The vertical limb of uterine manipulator is withdrawn and after detaching the major portion of uterus including the entire uterine cavity.

The endocervical lining is then cauterized with bipolar forceps.

The endocervical canal is closed with the barb suture followed by base ball suturing for haemostatic approximation of the remnant flaps.

Measurements and Main Results: N/A

Conclusion:

This technique is a viable option for young patients advised to undergo total hysterectomy because of abnormal uterine bleeding with severe dysmenorrhoea unresponsive to medical management and levonorgestrel implant but desire to have their ovarian function intact.