DISSECTING THE PELVIC RETROPERITONEUM AND IDENTIFYING THE URETERS A LAPAROSCOPIC TECHNIQUE

A technique for dissecting the pelvic retroperitoneum and identifying the ureters and uterine arteries is described that makes use of the ob literated hypogastric arteries. The obliterated arteries are readily i dentified laparoscopically and, as relatively fixed structures, are ea sily dissected free of the bladder and surrounding areolar tissues. On ce freed by blunt dissection, they are traced proximally to where they are joined by the uterine arteries to form the internal iliac arterie s. Blunt dissection just proximal and medial to the uterine artery wil l open the pararectal space, the medial border of which is bounded by the ureter. The uterine arteries are then traced to where they cross t he ureters and are freed from them by blunt dissection. The sire at wh ich the uterine arteries are divided and the extent to which the extra peritoneal spaces are developed and ureters mobilized off the medial l eaf of the broad ligament are tailored to the operation performed.