<h3>Study Objective</h3> To present a difficult anterior compartment surgery in which vascular clips were utilized to ligate the uterine arteries prior to dissection of the bladder from a lower uterine wall outpouching during a robotic-assisted hysterectomy. <h3>Design</h3> Demonstration of the technique using narrated surgery video footage. <h3>Setting</h3> The uterine blood supply is typically ligated at the level of the internal os during a typical hysterectomy. When adhesive disease presents abnormal anatomy, there are multiple methods to secure the uterine arteries. This includes identifying it at the pelvic brim branching from the internal iliac artery, identifying the median umbilical artery and tenting upwards to find the uterine artery origin, or following the ureter down to the ureteric tunnel as it crosses under the uterine artery. The latter method was used in this case and the uterine arteries were ligated with vascular <h3>Patients or Participants</h3> A patient with 6 prior cesarean deliveries and subsequent development of an anterior lower uterine wall outpouching was found to have malpositioned IUD within this defect, resulting is persistent pelvic pain. <h3>Interventions</h3> Robotic-assisted hysterectomy was performed in a case of extensive anterior compartment adhesions, with several strategies for safe dissection and minimal blood loss: 1. Placement of ureteral stents prior to start of case 2. Dissection of uterine arteries retroperitoneally down to the ureteric tunnels and ligation with vascular clips to secure blood supply prior to dissection of the bladder 3. Backfill the bladder to help define the peritoneal reflection between bladder and lower uterine segment 4. Assess for bladder injury by backfilling after dissection <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Here, we demonstrate several strategies for difficult bladder dissection from a lower uterine wall outpouching to minimize blood loss, maintain visualization, and avoid injury to bladder or ureters.