Surgical step | Our approach | One-step conservative surgery6 9 12 | Triple-P technique5 | Stepwise surgical approach10 |
Pelvic devasularisation | Bilateral ligation of uterine arteries at low and high levels. Then, anterior and posterior cervical wall control sutures |
| Inflation of pre-placed occlusion balloons in internal iliac arteries, with the interventional radiology service guidance | Bilateral internal iliac artery ligation |
Myometrial repair | Myometrial reconstruction in two layers |
| Compression sutures applied to the line of trophoblastic invasion into the UB, followed by uterine incision repair in two layers | Continuous mattress sutures, at 5 mm distance, everting the uterine edge to outside and including reflected peritoneum of UB with the lower uterine segment |
Dealing with placenta in case of percreta invasiveness | Dissected from the UB after neoformed vessels devascularisation. UB injury may happen, and is repaired | Dissected from the UB after neoformed vessels devascularisation. UB injury may happen, and is repaired | This portion of the invading placenta is left in situ and followed-up | Dissected from the UB after neoformed vessels devascularisation. UB injury or cystectomy may happen, and are repaired |
UB, urinary bladder.