Reverse Vesicouterine Fold Dissection for Laparoscopic Hysterectomy After Prior Cesarean Deliveries

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Nezhat et al1 invite comments in response to their article, as there is other published literature addressing bladder separation at the time of abdominal hysterectomy in women with a history of cesarean birth that was not included in their article. To wit, there are two specific issues:
This is an area of my own research, indexed and identifiable.2–7 As the authors reaffirm in their article, there is no iota of doubt that women with prior cesarean birth(s) are at risk for having the central three fifths portion of the undersurface of the bladder and the anterior cervicouterine surface densely adherent. Therefore, surgical separation requires use of the free space on both sides of the cervix (Fig. 1). It then becomes possible to separate the medial portion by working from lateral to medial. This free lateral space is called the uterocervical broad ligament space. This approach can be used vaginally or abdominally, with or without laparoscopic assistance. Sizzi et al8,9 have clearly mentioned the same space for bladder separation during laparoscopic and abdominal hysterectomy (Fig. 2).4
These omissions raise concern that the authors either disregarded or were unfamiliar with the previously published literature on this topic. In the era of Internet-based searches using a variety of available databases such as PubMed and Google Scholar, there is little excuse for omitting prior publications, especially when claiming priority on a topic.
The authors ideally should withdraw their words, “we describe,” “space has not been described before,” and “we refer to this space as a new space.

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