PMC5313353_01
PMC5313353_02
(A) Identification of the uterine artery and ureter. (B) Broad ligament suture for approximation. (C) Round ligament and anterior peritoneum in situ. (D) Lateral displacement of the ureter.
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F1
Following paravesical and pararectal space development, the uterine artery and ureter were identified (Fig. 1A). During this procedure, both posterior leaves of the broad ligaments were sutured and approximately retracted (Fig. 1B). The round ligament and anterior peritoneum were in situ during this procedure (Fig. 1C). Then the ureter was freed from the posterior leaf of the broad ligament down to the level where it entered the ureteral tunnel by using the Roticulator scissors (Covidien), and it was displaced laterally from the rectal pillar (Figs. 1D, 2A).
(A) Lateral displacement of ureter. (B,C) Ureter freed from paracolpos. (D) After pelvic lymphadenectomy and uterus removal followed by vault closure vaginally.
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PMC5313353_02_ogs-60-110-g002.jpg
F2
Then the ureter was freed from the posterior leaf of the broad ligament down to the level where it entered the ureteral tunnel by using the Roticulator scissors (Covidien), and it was displaced laterally from the rectal pillar (Figs. 1D, 2A). Next, the ureter was completely and easily freed from the paracolpos easily because it was already dissected previously (Fig. 2B, C). Lastly, the vaginal vault was closed vaginally (Fig. 2D).