Design: Case review and surgical video

Setting: The surgical case was performed at a tertiary care hospital. The patient was positioned in dorsal lithotomy position with arms tucked

Patients or Participants: A 44 year-old woman with a history of 5 prior cesarean sections presenting with abnormal uterine bleeding

Interventions: Patient underwent laparoscopic hysterectomy

Measurements and Main Results: The densely scarred bladder was dissected off the anterior uterus using a novel laparoscopic technique that combined a lateral approach with an understanding of preserved tissue planes after cesarean section, such that the correct dissection plane was found directly on the lateral aspect of the colpotomy cup and was continued transversely across the lower uterine segment.

Conclusion: A densely scarred bladder is best approached laterally in hysterectomy. The space medial and anterior to the uterine vessels at the level of the internal os is not violated in cesarean sections. This space can be used to isolate the pubocervical fascia and develop the bladder flap in a laparoscopic hysterectomy.