title: Additional uses of a vaginal fornices delineator.
abstract: A vaginal fornices delineator was introduced in the mid-90s by a gynecologic surgeon named Charles Koh as a device that would facilitate total laparoscopic hysterectomy. It is also used in robot-assisted and traditional laparoscopic hysterectomies. The delineator delineates the vaginal fornices and provides improved visualization of vital structures during a hysterectomy. The determination of the anatomic level of the cervix is vital in the identification of the inferior borders of a total hysterectomy and to avoid injury to the ureters and uterine vessels. As such, we describe 3 gynecologic surgeries in which the identification of this level was suboptimal. Our solution was to utilize a vaginal fornices delineator as the cervical "guide" to enhance this visualization and to allow for a complete and safe surgical outcome. The following surgical scenarios and the surgical facilitation provided by the vaginal fornices delineator will be presented: (1) a postpartum cesarean hysterectomy complicated by a large lower uterine fibroid tumor that distorts the cervix, (2) a robotic-assisted placement of an abdominal cerclage in a first-trimester pregnancy, (3) abdominal hysterectomy complicated by a necrotizing uterine infection and the associated difficulty in the identification of the cervicouterine junction.
authors.affiliation: Department of Obstetrics and Gynecology, University of Tennessee Chattanooga College of Medicine, Chattanooga, TN.
authors.forename: Shelly
authors.initials: S
authors.lastname: Gibbs
authors.affiliation: Department of Obstetrics and Gynecology, University of Tennessee Chattanooga College of Medicine, Chattanooga, TN.
authors.forename: Talla
authors.initials: T
authors.lastname: Widelock
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, University of Tennessee Chattanooga College of Medicine, Chattanooga, TN. Electronic address: rayan_kattah@hotmail.com.
authors.forename: Rayan
authors.initials: R
authors.lastname: Elkattah
authors.affiliation: Division of Gynecologic Oncology, University of Tennessee Chattanooga College of Medicine, Chattanooga, TN.
authors.forename: Stephen
authors.initials: S
authors.lastname: Depasquale
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000295:instrumentation* / Q000379:methods; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation* / Q000379:methods; D006473:Postpartum Hemorrhage / Q000601:surgery*; D011247:Pregnancy; D014591:Uterine Diseases / Q000601:surgery*
keywords: Koh Cup; cerclage; hysterectomy; robotic