**8.6 Disconnection of middle connective-vascular pedicle**

The middle pedicle is represented by the cardinal ligament that contains the main uterine vascular supply for the uterus and cervix. By caudal traction on the cervix, the vascular pedicle has a parallel direction on the uterine edge, removing the ureters from the surgical field (**Figure 17**).

For this reason, during the vaginal hysterectomy, the urethral risk is lower than with the abdominal approach. After clamping, the pedicle is cut and ligated with 2–0 Vicryl.

In some situations, the cardinal ligament can be well represented and cannot be clamped at a single time. In this case, a second clamping and cutting should be cautiously be done. There is the risk of clamping and cutting a part of the superior pedicle and, in the maneuver, tilting the uterus. If so, the latter might break, causing some unwanted bleeding.
