Modified Manchester-Fothergill for Prolapse in a Jehovah’s Witness Patient

Objectives: The purpose of this video abstract is to demonstrate step by step instruction with techniques for minimizing blood loss during a modified Manchester-Fothergill procedure.

Methods: Prior to recording, informed consent for obtaining images and video of the procedure was obtained. The video clips were selected and edited to create a cohesive and informative educational video, including English captions and narration. Measures were taken to protect the patient's privacy and confidentiality throughout the video creation process. The target audience for this education video are gynecologic surgeons, fellows, and residents.

Clinical Relevance: The Manchester-Fothergill procedure, created in the 1800s, involves removing the cervix and plicating the uterosacral and cardinal ligaments onto the previously amputated cervical stump. Our video introduces a modification of the Manchester procedure through incorporation of a uterosacral hysteropexy to assist in the apical suspension. The benefits of this surgery include offering a less invasive prolapse repair by avoiding peritoneal entry, thereby minimizing recovery. In addition, by avoiding a hysterectomy, blood loss is minimal during the Manchester procedure making this procedure ideal for patients who decline blood products. This procedure has been regaining popularity and has proven to be a durable native tissue approach as evidenced by a recent randomized control trial comparing 2- year composite success of the Manchester (87%) compared to the sacrospinous hysteropexy (77%). Patients with prolapse who are at higher risk for surgical complications, such as patients who are Jehovah’s witnesses, could benefit from a less invasive procedure while maintaining successful treatment of their pelvic organ prolapse by undergoing this modified Manchester-Fothergill procedure.