Alumi Laparoscopic Discussion Board

Cardinal Ligament should be taken with uterine artery or separately
Discussion in 'All Categories' started by Dr Simran Rastogi - Aug 17th, 2016 12:39 pm.
Dr Simran Rastogi
Dr Simran Rastogi
Dear Sir,

I want to know that during Total Laparoscopic Hysterectomy Cardinal Ligament should be taken with uterine artery or separately? The reason I want to explain because I have bleeding many times when I am coagulating uterine artery during hysterectomy. I tried to ligate intracorporeally but then also many times it bleeds.
re: Cardinal Ligament should be taken with uterine artery or separately by Dr R K Mishra - Aug 21st, 2016 7:44 am
#1
Dr R K Mishra
Dr R K Mishra
Dear Dr Rastogi

During the dissection of Cardinal ligament it should not be included with uterine. The most common locations of ureteral injury in pelvic surgery are at the cardinal ligament if attempting to take everything in one bunch where the ureter passes inferior to the uterine vessels.

When attempting to take everything together and if anatomy is little distorted, In these cases, the ureters are often deviated more medially and the careful identification of needs to be carried all the way down to the cardinal ligament.

During Total Laparoscopic Hysterectomy when gynecologist is approaching the cardinal ligament dissection, a few techniques can be very helpful to ensure that the ureter is sufficiently lateralized.

First, sufficient skeletonization of the uterine vasculature bundle. Which will ensure that any peritoneal attachments involving the ureter are completely released.

Second, it is important to maintain cranial deviation of the uterus with firm upward pressure on the uterine manipulator before coagulating ligating or incising the uterine vessels. Some gynecologists prefer to use upward traction on the uterine specimen with a laparoscopic tenaculum or myoma screw. Either approach will ensure the distance from the ureter.
re: Cardinal Ligament should be taken with uterine artery or separately by Dr Alisha - Sep 10th, 2016 11:01 pm
#2
Dr Alisha
Dr Alisha
Our professor is doing Total Laparoscopic Hysterectomy in half an hour in Istanbul goztepe hospital. He take entire uterine bundle with cardinal ligament with ligasure.
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