Atypical pelvic endometriosis localizations can occur in the cervix, vagina, round ligaments
, ureter, and nerves.
When managing the round-ligament complex on each side, stay between the round ligaments
(your "goal posts") to avoid getting too lateral.
attaches uterus on each sides, extends laterally, passes through the inguinal canal and terminates at the labia major.
Immediately after opening the abdomen round ligaments
could not be identified.
Surgical repositioning can also be done through laparotomy using the Huntington procedure, holding the round ligaments
and the uterus below the area of inversion and slowly pulling up repeatedly until the uterus is reinverted.
Once the round ligaments
are transected, the vessel sealer is replaced with the monopolar scissors.
At laparotomy the round ligaments
and fallopian tubes were noted to be pulled down within the cervical ring (Figure 4).
The round ligaments
run diagonally on either side of the pelvis.
Additionally, the uterus is restored to its correct anatomic position by shortening the round ligaments
I recommend a vessel-sealing device to secure the major blood supply, but I do suture the uterosacral and round ligaments
for attachment to the apex at the conclusion of the hysterectomy.
5) Both the round ligaments
were visualized, clamped and ligated.
The broad and round ligaments
then are coagulated and transected, and the bladder flap is developed.