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- W2916439869 abstract "The primary objective of this video is to describe an alternative technique for dissecting the bladder flap when adhesions from prior surgery and patients’ pathology alter urinary anatomy. Prior pelvic surgery is a major risk factor for urinary tract injury during laparoscopic hysterectomy due to scarring of the bladder to the prior uterine incisions. This causes fibrosis and dense adhesions in the midline. However, even when dense midline adhesions exist, the lateral borders of the bladder are free with minimal scar tissue present. Identifying the endopelvic fascia inferiorly and laterally, at the level of the colpotomy cup and uterine arteries, often reveals a clean plane to initiate a bladder flap dissection. Following this stepwise approach aids surgeons in identification of this plane. Since lysis of adhesions is the most common cause of bladder injury, this technique helps minimize injury and allows the laparoscopic surgeon to complete challenging cases with a minimally invasive approach. Scarring from prior surgery alters anatomy and increases the risk for urinary tract injuries during laparoscopic hysterectomy. By systematically identifying the endopelvic fascia from the low and lateral position, surgeons can develop a virgin tissue plane to dissect the bladder safely." @default.
- W2916439869 created "2019-03-02" @default.
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- W2916439869 date "2019-03-01" @default.
- W2916439869 modified "2023-09-25" @default.
- W2916439869 title "03: A stepwise approach to the difficult bladder flap to prevent urinary tract injury during laparoscopic hysterectomy" @default.
- W2916439869 doi "https://doi.org/10.1016/j.ajog.2019.01.137" @default.
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