Laparoscopic Subtotal Hysterectomy
Securing the Left Uterine Vessels
The first purchase is too far lateral. The second purchase captures the uterine vascular pedicle at the very cephalad edge of the vaginal ring.
After coagulation with the bipolar forceps, the pedicle is sharply transected, being careful to round the tip of the grasper.
The Kleppingers are applied just below the uterine vascular pedicle on the left side. After dividing the pedicle, the endoloop is again closed around the uterine vascular pedicle, being careful not to trap the end of the clamp in the endoloop itself. In this segment, additional assistance is needed to guide the endoloop around the tip of the clamp.
The endoloop is tied down as the grasper is simultaneously released.
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