Uterine Manipulation During Gynecologic Surgery: Practices, Preferences, and Operative Sequelae

Objectives: The objective of this study was to examine the current management and use of uterine manipulation during hysterectomies to improve surgical outcomes among ob/gyn surgeons in the United States.

Methods: A cross-sectional, anonymous, self-administered internet survey was developed using Confirmit software, between September and October 2022. The 26-question online survey included multiple choice and write in responses to evaluate current practices for uterine manipulation during hysterectomies as well as demographic information. Responses were analyzed using descriptive statistics.

Results: Of the 138 respondents, 63 of the respondents performed 50 or more hysterectomies each year, and 80% relied on an assistant to perform uterine manipulation. Surgeons reported elevation of pathology out of the pelvis and improved visualization as the reason to utilize uterine manipulators. In cases with manual manipulation, over 1/5 of cases noted assistant fatigue. Additionally, two thirds of respondents needed to instruct the assistant to adjust the manipulator because of fatigue or drifting. Almost all respondents (91.3%) reported static control of anatomical structures was important. Furthermore, of the respondents requesting adjustments, only 20% of respondents use the Uterine Positioning System to provide constant static pressure.

Conclusions: Respondents reported improved visibility with the use of uterine manipulation but was heavily dependent on assistant performance. In two thirds of cases, surgeons reported needing to adjust for assistant fatigue or drifting. The addition of a uterine positioning system to hold constant static pressure may be a viable alternative to manual manipulation.