Strategies for safe dissection of cervical fibroids during hysterectomy

Brought to you by the Society of Gynecologic Surgeons. In this video, the authors discuss safety considerations, principles of restoring normal anatomy, and surgical techniques for laparoscopic hysterectomy for a large cervical fibroid. Important safety considerations include the inability to place a uterine manipulator due to cervical distortion, abnormal anatomy of the uterine vessels and ureters, and increased collateral blood flow. Surgical techniques include: 1) placement of ureteral stents, 2) use of vaginal sponge stick or Briesky retractor, 3) complete ureterolysis, 4) double ligation of the uterine arteries at their origin and the internal cervical os, and 5) utilization of the cervical fibroid as the colpotomy border.