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Laparoscopic Subtotal Hysterectomy

Anterior Dissection and Development of the Bladder Flap

Before proceeding, adnexal adhesions are freed.

The left round ligament is held in its midportion, coagulated with bipolar forceps, and cut.
The anterior leaf of the left broad ligament is incised parallel to the uterus, and the incision is curved medially over the cervix.

The same two steps are repeated on the right side, and the incisions are connected. The bladder flap is mobilized out of the surgical field by cutting the cervicovaginal septum, as needed. Coagulation and cutting the superficial upper portions of the lateral vesicouterine ligaments or bladder pillars completes the dissection.