Lateral Approach to Uterine Artery & Scarred Bladder in Difficult TLH

327 Views | Oct 26, 2019

Authors: Li-Hsuan Hsiao, Fariba Mohtashami

Affliations: University of British Columbia

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.