After dropping the bladder flap
off of the anterior abdominal wall, the right-sided round ligament was ligated and transected to expose the right external iliac vessels.
A combination of traction and countertraction, small bites, and selective coagulation--one vessel at a time--is critical as dissection proceeds and the bladder flap
A bladder flap
was developed, the anterior sheath of the broad ligaments opened, and the ligaments were penetrated lateral to the ascending branches of the uterine artery.
When we created the bladder flap
, we entered the bladder and the fistula tract was exposed (Fig.
To outline the bladder flap
, the location of the Koh ring, VCare cup, or McCarus-Volker Fornisee at the cervicovaginal junction should be noted and used as a general target.
The broad and round ligaments then are coagulated and transected, and the bladder flap
In a recent prospective case series involving eight patients receiving ORC and 37 patients as controls, none of the ORC group was found to develop adhesions at the bladder flap
area when evaluated at a subsequent CD (single-site ORC application).
We find this helpful in manipulating the uterus and defining the cervical-vaginal junction, even during supracervical hysterectomies, because it helps in the dissection of the bladder flap
Forming a bladder flap
is very commonly done, but there's actually not much data to support it or refute this practice, said Dr.
These structures are divided, the anterior uterovesical fold is scored with the laser scalpel, and the bladder flap
closure was associated with a trend toward increased adhesions in all locations.
The adnexal pedicles are then divided, and the bladder flap
can be dissected to expose the uterine arteries, which are then clamped, divided, and ligated.