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Fig. 11.3. Laparascopic hysterectomy showing where instruments are inserted. The laparoscope is used to visualize the structures; the laparoscopic instruments include grasping forceps, scissors, cautery, and suture holders. Three or four small abdominal incisions are made to insert the laparoscope and the laparoscopic instruments.

tion of uterine rupture, uterine atony (a condition in which the uterine muscle does not contract properly after delivery), or other complications of delivery resulting in extensive blood loss that cannot be controlled by other means. A hysterectomy may also be electively done at the time of cesarean section for treatment of cervical carcinoma in situ, but we do not recommend this because of the increased blood loss that is typically associated with this procedure. Blood loss is greater when a hysterectomy is done on a recently pregnant uterus because the blood vessels are larger and bleed more profusely, and it is easier to damage the urinary tract by injuring the ureters or bladder.

Although cesarean hysterectomy may have been done in the past on an elective basis for women who desired sterilization, to treat uterine fibroids, and to treat cervical carcinoma in situ, rarely is this procedure performed electively today because of the increased risk of complications.

Part IV

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