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Bilateral clamps in this position will allow for elevation traction and rotation of the uterus which aid visualization dissection. These structures are clamped with two Kelly clamps close to uterus care being taken that lateral does not impinge on ovarian capsule. Bilateral incisions meet the midline | Total Abdominal Hysterectomy and Bilateral Salpingo ...

If adhesive disease impedes visualization here the ureter can be identified pelvic brim where it crosses iliac vessels their bifurcation. If however a clamp slips loose the anterior and posterior vaginal mucosa must be identified incorporated into closure prevent these edges from continuing bleed . Palpation and visualization in this area will ensure that the bladder if necessary rectum have been adequately mobilized

The vagina is incised just beneath cervix. If the ovaries are found to contain no pathology then decision retain or remove them must be based an informed discussion of risks and benefits removal management hormone replacement. Philadelphia JB Lippincott The ureter is visualized on medial leaf of broad ligament this space. A low transverse abdominal incision can be used if cancer not suspected. le function SharedLogHelper . Philadelphia JB Lippincott Cervix Removal and Cuff ClosureA closed technique for removing the from upper vagina is beneficial decreasing spillage of vaginal contents into abdomen. length f o sb ie return if function a var ge hps sj ce span url default homepage endChild try catch isHomepage http main cook SRCHS PC padding px margin . The laparoscope therefore assists vaginal hysterectomy and avoids abdominal incision when suspected uncertain adnexal pathology adhesive disease might otherwise preclude strictly approach

The most distal clamp placed first. When the surgeon enters peritoneal cavity upper abdomen is explored by visualization and palpation identify any adhesions masses. A second suture and or large hemoclip may be placed across the proximal portion of round ligament to prevent backbleeding. The bladder is gently lifted and its base visualized. A transfixion suture of delayed absorbable is placed through the distal portion round ligament and tagged Fig. As the vagina is being cut long Allis clamps are placed at both vaginal angles and anterior posterior walls Fig. The lowest clamp is placed first and at level of internal cervical os. The posterior leaf of broad ligament may also be incised parallel to toward side wall. This can be held by assistant and moved from right to left with visualization each side the hysterectomy progresses Round Broad LigamentsA Kelly clamp placed immediately lateral uterus cornua incorporates isthmic portion of fallopian tube uteroovarian within its grasp. If the bladder is densely adherent to cervix in midline lateral areolar spaces can be developed approaching help define appropriate plane between and prelude sharp dissection