8891 Visiting the Posterior Leaf: 5 Steps to Set You up for a Successful Hysterectomy

Abstract

<h3>Study Objective</h3> The objective of this video is to provide surgical tips for easy and safe dissection of the posterior leaf that can be used routinely during both simple and complex cases. <h3>Design</h3> Video case presentation. <h3>Setting</h3> The surgeries in this video were performed in the operating room at an academic medical center. The patient was positioned in dorsal lithotomy position. Laparoscopic hysterectomy was completed using a 5mm umbilical port, a 5mm left lower quadrant port, 5mm right lower quadrant port, and a 5mm suprapubic port. <h3>Patients or Participants</h3> This video is made from a compilation of 4 laparoscopic hysterectomies. <h3>Interventions</h3> Total laparoscopic hysterectomy. <h3>Measurements and Main Results</h3> Potential complications of laparoscopic hysterectomy include bleeding, ureteral injury, and conversion to laparotomy. This technique creates pedicles for easier ligation and hemostasis and allows for visualization of the lateralized ureter. The steps are as follows: 1. Open the anterior leaf to create the bladder flap 2. Identify the posterior leaf of the broad ligament 3. Make a window in the posterior leaf 4. Extend the window to lateralize the ureter 5. Isolate the utero-ovarian and uterine pedicles. Various methods were used to successfully create a window in the posterior leaf. These steps are reproducible for both simple and complex cases. <h3>Conclusion</h3> Laparoscopic hysterectomy can be safely performed with minimal blood loss using the techniques described in this video.