Journal of Minimally Invasive Gynecology | 2019
2878 Posterior Approach to Uterine Artery Ligation
Abstract
Video Objective This video demonstrates an alternative approach to uterine artery ligation during a Robotic Assisted Total Laparoscopic Hysterectomy in the setting of an obliterated anterior cul-de-sac. Setting This a case of a 29 year old with two prior cesarean sections presenting for Robotic Assisted Total Laparoscopic Hysterectomy for abnormal uterine bleeding. Upon entry, the uterus is found to be densely adherent to the anterior abdominal wall. Interventions The uterine arteries were dissected out, desiccated, and transected from the posterior aspect of the uterus due to the limited access anteriorly secondary to bladder adhesions. Conclusion In conclusion, an obliterated anterior cul-de-sac due to previous surgeries makes it difficult to access the uterine arteries secondary to poor visualization. By approaching uterine artery ligation from the posterior aspect, one may avoid inadvertent injury to vasculature or the bladder and reduce the amount of bleeding during the bladder dissection.