8281 Anterior Cul-De-Sac Obliteration: Dissection of a Difficult Bladder Flap.
In: Journal of Minimally Invasive Gynecology, Jg. 29 (2022-11-02), Heft 11, S. S121
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Zugriff:
This video highlights techniques for dissection of an obliterated anterior cul-de-sac in a patient undergoing hysterectomy. N/A. This surgery was performed at a tertiary academic referral center. This is a 56-year-old with history of 3 cesarean sections and a large central anterior fibroid who has failed medical management for abnormal uterine bleeding. The patient underwent a robotic-assisted hysterectomy with bilateral salpingo-oophorectomy. The fibroid was densely involved in adhesions to the bladder flap area. The colpotomy cup was not visible. The posterior leaf of the broad ligament was incised to skeletonize the uterine artery. This posterior approach helped show both the artery and the colpotomy cup. The anterior leaf of the left broad ligament was dissected. Filmy serosal attachments along the fibroid were taken down. This process was repeated on the right side. There were thick attachments near the adhesive band, and bleeding was encountered. To decrease the vascular supply to the uterus, bilateral uterine arteries were ligated. Subsequently, the band was taken down with minimal blood loss. This is typically the area of the thickest scar tissue. The surgeon can place an instrument inferior and lateral to the adhesions and create a tunnel to guide the dissection. We backfilled the bladder with sterile saline to clearly delineate the extent of the adhesions. Once the scar was incised, the bladder flap was further developed. The uterine arteries were separated and the colpotomy was completed. The vaginal cuff was closed, and the procedure was concluded. The patient was seen for 3 years for medical management, and she opted for surgery due to ongoing symptoms. She was seen for a 6-week follow-up visit. It is imperative to safely dissect the bladder away from the uterus in cases of anterior obliteration. Techniques include backfilling the bladder, approaching adhesions laterally and inferiorly, and de-vascularizing uterus. [ABSTRACT FROM AUTHOR]
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Titel: |
8281 Anterior Cul-De-Sac Obliteration: Dissection of a Difficult Bladder Flap.
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Autor/in / Beteiligte Person: | Lewis, G.K. ; Ayala, M.G. Duarte ; Palin, H. ; Carrubba, A.R. |
Zeitschrift: | Journal of Minimally Invasive Gynecology, Jg. 29 (2022-11-02), Heft 11, S. S121 |
Veröffentlichung: | 2022 |
Medientyp: | academicJournal |
ISSN: | 1553-4650 (print) |
DOI: | 10.1016/j.jmig.2022.09.392 |
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