Reply to the comments on "Modified hysterectomy for placenta increta and percreta: modifications of what?"
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I thank Dr. Matsubara et al. for their comments, they had asked “what about our technique is new?”, however, we are not presenting a new novel surgical technique but rather a modification of the already known type II radical hysterectomy that was described by Cibula et al.  to manage cases with abnormally invasive placenta (AIP). Our modification of this technique includes a systematic standardized stepwise approach that avoids unneeded extensive dissection of the parametrium and less need for total hysterectomy, which when applied to most cases of AIP improves outcomes and also shown by our results .
Dr. Matsubara et al. mentioned that opening the retroperitoneum as the first step cannot be usually done in patients with AIP as the entire pelvis is usually occupied by the uterus, however, there is no reported data on the incidence of posterior invasion in cases with PAS disorders, and in our experience posterior bulging of the placenta into the pelvis is very rare . This...
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All authors declare that they have no conflict of interest.
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