Sinha Rooma, Rupa Bana, Peddappolla Shilpa Chowdary
Minimal Access Surgery Unit, Department of Gynecology, Apollo Health City, Jubilee Hills, Hyderabad, IND.
Department of Gynecology and Robotic Surgery, Apollo Health City, Jubilee Hills, Hyderabad, IND.
Cureus. 2025 Aug 17;17(8):e90280. doi: 10.7759/cureus.90280. eCollection 2025 Aug.
Intraoperative adhesions, particularly between the bladder and cesarean scar, as well as between the uterus and anterior abdominal wall, are commonly encountered in patients with a history of cesarean sections. These adhesions substantially elevate the risk of severe intraoperative complications, including bowel or bladder injuries, during hysterectomy. The incidence of bladder complications is significantly lower in patients with one or two prior cesarean sections compared to those with three or more. Moreover, the likelihood of inadvertent cystotomy is several times higher in patients with three or more cesarean sections than in those with no prior cesarean sections. Here, we report a simple, safe, and reproducible approach for bladder dissection. This innovative technique, developed by us, is particularly effective when the lateral window cannot be identified. With the rising incidence of cesarean sections, surgeons are increasingly encountering dense bladder adhesions during hysterectomies. The Head-On technique was developed specifically for bladder dissection in such cases to minimize the risk of urogenital tract injuries.
术中粘连，尤其是膀胱与剖宫产瘢痕之间以及子宫与前腹壁之间的粘连，在有剖宫产史的患者中很常见。在子宫切除术中，这些粘连会大幅增加严重术中并发症的风险，包括肠道或膀胱损伤。与有三次或更多次剖宫产史的患者相比，有一两次剖宫产史的患者膀胱并发症的发生率显著更低。此外，有三次或更多次剖宫产史的患者无意中膀胱切开术的可能性比无剖宫产史的患者高出数倍。在此，我们报告一种简单、安全且可重复的膀胱分离方法。我们开发的这种创新技术，在无法识别侧窗时特别有效。随着剖宫产率的上升，外科医生在子宫切除术中越来越多地遇到致密的膀胱粘连。迎头技术就是专门为这类病例的膀胱分离而开发的，以尽量降低泌尿生殖道损伤的风险。
