Blunt dissection technique with finger and vessel skeletonization in the posterior vesical wall for abnormally...

Purpose: This study described a new technique to minimize the bleeding resulted from aberrant engorged vessels and unintended bladder injury in cases with abnormally invaded placenta adjacent to posterior bladder wall at cesarean hysterectomy.Methods: After filling the bladder with 300 ml saline aberrant engorged vessels were identified and skeletonized between lower uterine segment and bladder with blunt dissection by index finger down to the distal end point of cervix.Results: This technique has beneficial effect on preventing bladder injury and reduces bleeding resulting from the aberrant vessels and the communicating vessels that were based around the vesicouterine fold and the cervico-vesical interface (in the lower part of the cervix); respectively.Conclusion: Our procedure may have some benefits including shorter operation time, lower amount of hemorrhage, and less bladder injury where anatomical landmarks are unclear, especially in abnormally invasive placentation adjacent to posterior bladder wall at cesarean hysterectomy.