LAUSR

Study Objective The rate of vaginal hysterectomy (VH) continues to decline likely due to the difficulty in performing the procedure, lack of adequate surgeon exposure and training and declining hysterectomy numbers. Dissecting the anterior cul-de-sac is a rate limiting step of the procedure due to incomplete dissection of vaginal attachments to the cervix, adhesions from previous surgeries, minimum uterus descensus and concern for bladder injuries. The objective of this video is to demonstrate 5 key surgical principles that can be used to facilitate the dissection of de anterior cul de sac. Videos from the laparoscopic approach will be brought in to emphasize these principles and techniques. Design N/A Setting N/A Patients or Participants N/A Interventions N/A Measurements and Main Results N/A Conclusion Dissection of the anterior cul-de-sac is a critical step in vaginal hysterectomy. We consider that this principles can help the surgeon to succeed: Completely excise the vaginal attachments from the cervix, incise the posterior leaf of the broad ligament, isolate uterine arteries bilaterally from posterior, dissect adhesions from lateral to midline and morcellate to decompress and achieve anterior descensus.