A stepwise approach to the difficult bladder flap to prevent urinary tract injury during laparoscopic hysterectomy

Brought to you by the Society of Gynecologic Surgeons. In this video, the authors demonstrate the surgical techniques necessary to develop a bladder flap during a total laparoscopic hysterectomy when scar tissue from prior surgeries exists. The video highlights key steps in identifying the endopelvic fascia laterally at the level of the uterine arteries to develop a virgin tissue plane, which can be dissected medially toward the scarred area. Utilization of this strategy helps the surgeon restore normal anatomy and prevent urinary tract injuries during total laparoscopic hysterectomy.