Challenging TLH in Ventrofixed Uterus with Adenomyosis | Post-Cesarean Adhesions скачать в хорошем качестве

Challenging TLH in Ventrofixed Uterus with Adenomyosis | Post-Cesarean Adhesions

In this video, we present a step-by-step demonstration of Total Laparoscopic Hysterectomy (TLH) in a complex case of adenomyosis with a ventrofixed uterus due to two previous lower segment cesarean sections (LSCS). ▶️ Surgical Highlights: • Dense adhesions were noted between the anterior uterine surface and the abdominal wall. • Careful adhesiolysis was performed, taking special caution to avoid injury to the superior surface of the bladder and to prevent inadvertent entry into the myometrium, which can increase intraoperative bleeding. • Bilateral uterine pedicles were secured and coagulated. • The bladder was dissected and pushed down using both sharp and blunt dissection. • Once the uterine manipulation reached the vaginal fornices, identification of the cervix was aided by the bulging of the uterine manipulator cup. • The specimen was retrieved vaginally. • The vaginal vault was closed laparoscopically using intracorporeal suturing: square knot technique on one side and sliding knot technique on the other. • Uterosacral ligaments were incorporated into the vault closure for support. 💡 This video provides valuable insights into managing dense post-cesarean adhesions, safe bladder dissection, and meticulous vault closure techniques in challenging laparoscopic hysterectomy scenarios. 🔍 Indication: Symptomatic adenomyosis with failed medical therapy 🔍 Challenges Addressed: Ventrofixed uterus, bladder adhesions, post-LSCS scarring Thanks for watching.Please do subscribe. Please visit my faceboook page   / ravikanth.gowder   Please visit my instagram page www.instagram.com/drravikanthgo please visit twitter page  / drravikanthgo