ABSTRACT

The operation begins similar to a simple complete hysterectomy. The remaining uterine cervix is grasped with forceps and firmly pulled towards the vaginal orifice (figure 7.2). Here, a trick frequently used in vaginal surgery is applied: a primary posterior incision (figure 7.3). Similar to abdominal surgery, this accentuates the mobility of the uterine cervix and allows better anterior access. Because above all, the natural adhesion to the

bladder poses a problem during simple trachelectomies. In the present case, one also notices an adhesion to the rectum which is treated similarly to the anterior adhesion to the bladder: the visible septum joining the vagina and the rectum is cut in the median plane, half-way between the incision’s edges (figure 7.4). Further up along the posterior side of the uterine cervix we will find the Douglas’ pouch (figure 7.5). It is located quite high up.