All these circumstances of his professional life were triggers to investigate in details existing

techniques of laparotomy and caesarean section, among which Joel Cohen and Misgav Ladach, and
initiated idea of the new modification of caesarean section.
Vejnovic modification of caesarean section technique was developed in 2000. It includes
changes in each step of the operation. More important, it introduced new logic of the operation —
immitating the mechanisms of vaginal delivery, using same factors of delivery, but making new,
virtual birth canal in the abdominal wall. During the years of testing, observing and comparing,
important details of the technique were distinguished and their clinical effects were hypothesized or
proven.
Basic principles of Vejnovic modification are:
1. Minimal traumatisation of the mother and the fetus
2. Maximal shortening of the operative time
3. Immitation of the vaginal delivery (nature).

Description of the operative technique:

Every operation begins with adequate preparation of the patient and operative field, thorough
surgical hand washing and disinfection. Caesarean section has to be considered major surgical
operation, because the complications are major and sudden. Caesarean section is operation with time
limit. This is why operator should always access to the patient with respect and care, and be
concentrated no matter if it is elective operation or urgent caesarean section in the middle of the night.
"Think of caesarean section as it is an apnea diving. Do not start if you did not take deep
breath andfocused your mind."
Laparotomy
Skin incision
"By the incision of the skin and uterus you are tailoring the destiny ofyour operation"
There is a simple rule to determine right place to make incision on the skin. Operation should
begin at the site of a natural fold of the skin that can be vizualized by wrinkling the abdominal skin
downwards (Figure 2).

Figure 2. Skin incision site. Natural fold of the skin (scheme le.ft, live right)

This place corresponds to the insertion of underlying pyramid muscles, which makes other
steps of the laparotomy easier to perform. In small percentage of the patients where natural fold cannot
be vizualized, incision should be made 3-4 cm above the upper rim of pubic symphysis.
Incision should be straight transverse and initially not longer than 10-12 cm because this is the
average range of occipitofrontal diameter of fetal head. It is an illusiou that big incision will make
extraction easier and vice versa.

"You can always make small incision bigger. bza cannot ervr make big scar smaller."