Lateral Approach for Bladder Dissection

Bladder dissection in laparoscopic hysterectomy presents challenges, particularly in patients with prior cesarean deliveries. This chapter proposes a systematic three-step approach to bladder dissection, emphasizing the mitigation of genitourinary tract injury risks. Initially, securing the uterine arteries at origin minimizes blood loss and enhances visualization. The chapter underscores initiating dissection laterally and inferiorly to identify a virgin tissue plane, crucial for minimizing bladder injury. Subsequently, techniques for delineating bladder borders, such as bladder backfilling, aid in precise dissection. Through detailed surgical descriptions and a case study, surgeons are guided in navigating the complexities of bladder dissection, ensuring meticulous technique and anatomical comprehension. This approach facilitates successful outcomes in laparoscopic hysterectomy procedures, particularly in cases with dense bladder adhesions secondary to cesarean deliveries.