**8.1 Incision of the vagina around the cervix**

The incision of the vaginal wall can be done with a cold or electric scalpel. The incision of the vagina around the cervix is circular, with the anterior limit in the first transversal fold of the vaginal mucosa from its insertion into the cervix (*sulcus vesicalis*). The posterior limit should exceed the level of the cervical insertion of the two uterosacral ligaments (*torus uterinus*) in providing the closest access to open the pouch of Douglas. (see Chapter 6).

The incision includes the entire thickness of the vaginal wall, anteriorly and posteriorly. Laterally only the epithelium is interested. In this way, with the ligature of the first pedicle, the vagina will remain anchored sideways to the uterosacral ligaments, ensuring the prevention of the vaginal vault prolapse (**Figure 9**).

#### **8.2 Developing anterior cleavage space (dissection of the bladder)**

Entry into the anterior cleavage space starts with opening the vesicouterine space by cutting the *cervico-vesical septum.* After that, the vesicouterine space is entered digitally. In cases where there are scars after cesarean sections, it is recommended that the detachment be done with the scissors advancing less in the cervical plane or by "lateral window" (see Chapter 6) (**Figures 10** and **11**).

The peritoneal vesicouterine fold remains up as long as the uterus keeps its connections with the superior connective vascular pedicle. For this reason, its opening is not an immediate objective once the bladder has been detached from the uterus.
