Ref: Steps of internal iliac artery at its origin

I have no video. I am sorry,

Tips are as follows.

Tip 1: First step is 1) To cut open the pelvic peritoneum at brim and to insunate your finger inside the nick made in the peritoneum and to create a wide space in the retroperitoneal area .

This will expose common iliac artery, bifurcation of C iliac, ext iliac a & vein and int iliac artery and vein.

Ureter will be in the medial aspect which will remain attached to the pelvic peritoneum as it receives many blood vessels from small vessels of the peritoneum. One can roll and palpate the ureter or can observe the peristalsis.

 Step 2: Then the sheath of the common iliac artery be cut by lifting the arterial sheath  by an Allis tissue forceps. It is hard to damage a big artery, like that .By gentle snaps of scissors the sheath of the common iliac artery should be boldly cut  and arterial sheath should be dissected down for  about 3 cm down the commencement of Common iliac artery. Such baring of the C iliac trunk  will show the  bifurcation of Common iliac which can be easily be observed .One can identify  External iliac artery as more thick, longer than int iliac 

.Step 3.  Palpate the pulsatile vessels as arteries will always pulsate. If in doubt, one can feel the pulsation of ext iliac and  int iliac A . However in a shocked woman the pulsation will be feeble.

Step 4: Make int iliac a free from its under surface : Thereafter one should lift the int iliac artery with a tissue forceps and by aneurysm needle(if available) or by a curved artery forceps the int iliac base i.e under surface should be kept free from  underlying bones and tissues enabling a suture to be passed.  This is a critical step as Int iliac vein remains very close by and one has to avoid any injury to init iliac vein. If aneurysm needle is available then no 1 silk should be threaded in the hole of the aneurysm needle and drawn outwards. Then  two separate knots are applied on Int iliac artery

Tip 5:  Before putting the silk knots it is a wise policy to show the bifurcation of C iliac to ext and int iliac to Asstt or on lookers at O T. So inadvertent ligation of Ext iliac is not done. The other side should have similar procedures. The cut perineum is stitched by interrupted 4 to 5 00 catgut avoiding any  kinking in ureters.

Tip 6: Inadvertent injury to any vein will stop by firm pressure by moist mops for at least 15 minutes which require great patience. Presence  of vascular clips will go a long way to secure venous damage, Ureters and arteries are seldom damaged in the process.