The Bermuda`s Triangle a Didactic Description of the Retroperitoneal Anatomy

Abstract

Study Objective The objective of this video is to teach an ¨effective¨ technique to find and clip the uterine arteries, previous to a total laparoscopic hysterectomy (TLH). Design video article. Setting Private Hospital. Patients or Participants N/A Interventions Hysterectomy is one of the most common surgical procedures around the world; Just in the USA, around 600,000 procedures are done yearly. The total laparoscopic hysterectomy has become one of the most common used techniques. According to the actual literature, the complication rate is in the range of 5.7/1000 procedures and bleeding is one of the most stressful complication. The purpose of this video article is to describe ¨The Bermuda´s Triangle¨ a very didactic description of the retroperitoneal vascular anatomy; With this description, it will be extremely easy to find and clip the uterine arteries, before performing a total laparoscopic hysterectomy. We named The Bermuda`s Triangle, because on the Atlantic Ocean the Bermuda's triangle is one of the most enigmatic and scare places, the same happened with the retroperitoneal space With the uterine arteries occluded, we decrease the uterine blood supply by 79%. After the initial anatomic pelvic inspection, we will see the pelvic side wall, we can draw an inverted triangle, that is formed from the superior side by utero-ovaric ligament, from the inferior side by the ureter and from the external side from the IP ligament, at the middle of the triangle we are gaining access into the retroperitoneal space; it will be quite easy to identify the vascular structures, nerves and ureter. The internal iliac artery will be identified, giving a bifurcation into uterine artery and superior vesical artery. The titanium clips are placed on the uterine artery. Measurements and Main Results N/A Conclusion The uterine arteries are clipped at the base, in an extremely easy and safe style. Doing this, we are decreasing the chances of a hemorrhage.