Proximal Uterine Artery Ligation: Navigating Anatomical Distortion of Large Fibroids During Hysterectomy

Apr 15, 2019 | 213 Views

Wilson Chan, Chandrew Rajakumar

This video outlines a technique for performing ligation of the proximal uterine arteries. This is a technique that can be used to mitigate blood loss during hysterectomy.

Routine Anterior Colpotomy Prior to Ligation of the Uterine Artery at the Time of Laparoscopic Hysterectomy

Sep 27, 2019 | 231 Views

Angela Deane, Liane Belland

We present an alternative approach to securing the uterine pedicle during laparoscopic hysterectomy by initiating the colpotomy prior to uterine artery ligation. We review the traditional approach to securing the uterine pedicle and then demonstrate our alternative approach in a simple laparoscopic hysterectomy and in complex cases involving endometriosis and fibroidsCreation of the colpotomy prior to securing uterine arteries has several advantages. It improves surgical technique through clear delineation of anatomy, improving patient outcomes based on limited data and our experience. This technique improves surgical education and comfort with anatomy for learners. It is easy to teach and versatile for use in both simple and complex cases.

Lateral Approach to Uterine Artery & Scarred Bladder in Difficult TLH

Oct 26, 2019 | 482 Views

Li-Hsuan Hsiao, Fariba Mohtashami

Ligating the uterine arteries is a key step in successfully performing a total laparoscopic hysterectomy. However, in the presence of pelvic pathology, the anatomy can be significantly distorted making visibility and accessibility difficult. Securing the uterine arteries at the origins of the internal artery is a useful technique for any gynecologists performing hysterectomies. In this total laparoscopic hysterectomy, we encountered an obliterated anterior cul-de-sac from the previous Caesarean section scar and an inaccessible posterior cul-de-sac from a large posterior fibroid. Since it was not possible to ligate the uterine arteries at the level of the internal cervical os, we decided to use the lateral approach to ligate the uterine arteries by dissecting the pararectal fossa. This video aims to highlight the importance of identifying landmarks, hemostatic dissection, and adaptive intraoperative planning.