Brought to you by the Society of Gynecologic Surgeons. The most cosmetically beneficial approach to hysterectomy is the vaginal route. When clinical circumstances exist to make the vaginal approach less feasible, effort to limit incisions to the umbilicus has cosmetic benefits. This mid-line umbilical approach creates several challenges due to the loss of instrument triangulation. The following video demonstrates several techniques to overcome the challenges that arise from the loss of port placement triangulation.