About Video

This video presents a case of 42year-old patient, present complaints: something coming out of vagina for last 8 years following total abdominal hysterectomy. Present complaints menorrhagia and dysmenorrhea for 2 years and urine leakage on coughing and sneezing for 6 years. Preoperative diagnosis: adenomyosis with stress urinary incontinence (SUI). Port placement: patient laid in modified lithotomy position under GA. Four ports laparoscopy done, all 5 mm ports except camera port which is 10 mm. Surgical procedure: after total laparoscopic hysterectomy bladder distended with 200 mL normal saline. Entry made into space of Retzius by incision on the peritoneum 2 cm superior to the dome of bladder between the two obliterated umbilical ligaments. Harmonic ACE is used to make the incision. Pubic ramus and Cooper’s ligaments visualized during dissection of the cotton candy space of Retzius. Now bladder drained out. Urethrovesical junction identified. Vaginal wall lateral to bladder neck lifted up by a vaginal finger. Two prolene 1-0 stitches passed on either side in the paraurethral tissue, which are anchored to the Cooper’s ligaments. These sutures are just meant to be like slings and are not tied too tightly. At the end peritoneum sutured with prolene 1-0 in purse-string manner.