Observation on the efficacy of vaginal hysterectomy I. Surgical method Negative total hysterectomy operation: the patient took the truncated position, routine disinfection, laying towel, catheterization, exposure of the cervix. In the bladder groove and the posterior fornix and cervical junction of the intermediate submucosal injection of 1u plus saline mixture of 20 ml. in the bladder cervical groove about 3mm below the cervical cervical incision of the cervix and vaginal junction of the mucous membrane, the depth of the cervical mucosa of the cervix of 3 ~ 4mm, the scalpel bluntly and sharply separation of the bladder cervical interstitial space and cervico-rectal interstitial space, up to the anterior and posterior peritoneum folds, open the anterior and posterior peritoneum by the cervix of the one-time clamping of sacral ligaments, and then cut and suture the proximal severed end of the ligaments. The cervical side of the uterus was not sutured. At this time, touch the uterus again to find out the size of the uterus, mobility, position of the fibroid, etc., and then proceed with further treatment according to the specific situation. If the uterus is large and difficult to pull out, we can use cervical cyanosis to clip both sides of the cervix, and cut the uterus in half from the cervix, if the tumor affects the uterine descent, the fibroid will be removed at any time, and at the same time, combined with uterine fragmentation, nucleotripsy, etc., which is expected to reduce the size of the uterus and then pull it out effectively. If the uterus is not large, the adnexa is pulled out by touching it with the index finger, and the ligaments of the ovaries on both sides are broken under direct visualization. If the adnexa has lesions, the suspensory ligament of the ovary will be broken, or the uterus can be cut down and then deal with the nearby pieces; the tail of each stump is retained, but avoid pulling, and after checking that there is no bleeding, the tail of the thread is cut off, and the peritoneum and the vaginal mucous membrane are closed with one layer of consecutive interlocking sutures, and the vagina is stuffed with gauze ball to stop the bleeding with compression. Post-operative results: 1. 16 cases in the group of vaginal total hysterectomy were simple total hysterectomy, 1 case of unilateral adnexa and 1 case of bilateral adnexa resection. In the abdominal total uterus group, there were 15 cases of simple total hysterectomy, 2 cases of unilateral adnexa and 1 case of bilateral adnexa resection. Comparison of operation time, intraoperative bleeding, postoperative analgesia, anal exhaustion time, hospitalization days, surgical satisfaction and sexual life satisfaction between the two groups. Follow-up results: both groups had no lower abdominal pain, sexual life satisfaction, vaginal examination and pelvic examination, vaginal stump healing in the vaginal hysterectomy group, no polyps, no inflammatory pelvic mass and hematoma. Conclusion: Negative hysterectomy, with the advantages of no abdominal incision, no scarring on the body surface, less pelvic and abdominal interference during surgery, and fast postoperative recovery, etc. [2], due to the narrow surgical field, relatively difficult to expose and operate, resulting in a slightly longer surgical time, and unfamiliarity with the local anatomy caused by fewer applications in the usual practice, it has not been widely used, and is mainly used for some patients with uterine prolapse. In today’s world of minimally invasive surgery and human-oriented, patients are more likely to accept transvaginal hysterectomy. This study shows that the operation time of the vaginal group is longer than that of the open group, the intraoperative bleeding is slightly more (P<0.05), the number of days of hospitalization after operation and the time of postoperative anal defecation are less than that of the open group, and the comparisons are significant (P<0.01), which means that compared with the transabdominal surgery, it has a relatively long operation time and a little bit more bleeding, but it doesn't affect its feature of fast postoperative recovery. Satisfaction with surgery in the vaginal group was significantly higher than that in the abdominal group (P<0.01), while there was no significant difference in sexual life satisfaction between the two groups (P>0.05), indicating that patients are more likely to accept transvaginal hysterectomy. Surgical experience: to eliminate from the ideology of the vaginal hysterectomy complex, not easy to expose, easy to damage the surrounding organs and other adverse concerns, the key to the operation is to be familiar with the relationship between the anatomical location of the pelvic cavity, intraoperative bold and careful, as long as the separation of the tissue level is clear, it can be avoided completely bleeding and damage to the surrounding organs, skilled operating time can be greatly reduced. The key to reduce intraoperative bleeding is to have a clear anatomical level and skillful basic operation. Because the cervical bladder space and cervicorectal space are rich in blood transportation, it is very easy to bleed and bleed, using the standing hemostatic solution for hydrodynamic separation of the gap not only reduces intraoperative bleeding, but also makes the gap easy to be separated, and the use of the electrocutter for separation during the operation can significantly reduce the bleeding and make the surgical field clear. The mucous membrane at the junction of cervix and vagina was circumcised at 3mm below the bladder, 3~4mm deep to the cervical fascia. If the incision was too shallow, there would be more bleeding and the bladder layer would be easily injured during the separation, while if it was too deep, it would not be easy to separate the anterior cervical fascia because it had been cut. If the depth of incision is well controlled, the bladder-cervical space can be easily separated. Due to the small surgical field, the tissue must be clamped close to the uterus. Instead of routinely turning out the uterus and treating the adnexa, the operator gave his index finger to pull out the adnexa, and then ruptured the intrinsic ligament of the ovary and the round ligament under direct visualization at one time. All ligamentous tissue stumps were firmly sutured at one time, except for the uterine arterial and venous severed ends and adnexal severed ends, which not only shortened the operation time, but also reduced the bleeding. The vaginal mucosa and peritoneum are sutured in a single layer without leaving a dead space, which reduces postoperative pelvic hematoma and saves surgical time by omitting the steps of tying the ligamentous stumps to each other. Since the uterus is not prolapsed, it is not necessary to reconstruct the pelvic floor support structure [3]. In this procedure, the adnexal stump is not embedded in the vaginal stump, so postoperative pain during sexual intercourse can be avoided, and it is also less likely to cause infection of the adnexal stump and pulling of the lower abdomen. The vaginal stump and peritoneum are sutured with a layer of absorbable thread, which does not leave a dead space, and there is no postoperative bleeding and polyp formation on the stump. Transvaginal total hysterectomy has the advantages of less trauma, faster recovery, no abdominal incision, etc. It is suitable for those with benign uterine lesions and no pelvic adhesions. Transvaginal hysterectomy is not suitable for those who have various types of gynecological malignant tumors, pelvic adhesions, huge uterine fibroid tumors, as well as those who have narrowed vaginas. Today, when minimally invasive surgery is advocated, total hysterectomy should be preferred to the transvaginal route when the technical conditions are ripe and there are no contraindications.