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Reverse Vesicouterine Fold Dissection for Laparoscopic Hysterectomy After Prior Cesarean Deliveries

Nezhat, Camran MD; Grace, Lindsey A. MD; Razavi, Gity M. MD; Mihailide, Catalina; Bamford, Holden

doi: 10.1097/AOG.0000000000001593
Contents: Procedures and Instruments

BACKGROUND: Cesarean delivery adhesions, during laparoscopic hysterectomy, can present surgical challenges, including distortion of anatomy, prolonged operating time, and inadvertent injury to nearby structures.

TECHNIQUE: At the time of laparoscopic hysterectomy, in patients with significant adhesions from prior cesarean deliveries, we use a reverse inferior to superior vesicouterine fold dissection to mobilize the scarred bladder. We use this as an alternative to the commonly practiced technique of mobilizing the bladder in a superior to inferior fashion at the time of laparoscopic hysterectomy.

EXPERIENCE: Fifty-two patients with a median age of 42.5 years are presented. Forty-eight patients were discharged within 3–6 hours postoperatively. Sixteen patients were discharged with Foley catheters, because they were unable to void within the protocol for a fast-track discharge. The catheters were removed between postoperative days 1 and 5. There were no gastrointestinal or genitourinary complications. One patient experienced a delayed vaginal cuff abscess and bleeding, which were managed conservatively.

CONCLUSION: Reverse vesicouterine fold dissection is a useful alternative technique for laparoscopic hysterectomy in women with a history of prior cesarean deliveries.

Reverse vesicouterine fold dissection is a useful alternative technique for laparoscopic hysterectomy in women with a history of prior cesarean deliveries.

Center for Special Minimally Invasive and Robotic Surgery and Stanford University, Palo Alto, and the University of California at Berkeley, Berkeley, California.

Corresponding author: Lindsey A. Grace, MD, Center for Special Minimally Invasive and Robotic Surgery, 900 Welch Road, Suite 403, Palo Alto, CA 94304; e-mail: lindseygrace@camrannezhatinstitute.com.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.