Total laparoscopic hysterectomy when there is posterior cul-de-sac obliteration: a step-by-step nerve-sparing technique

Dense adhesions because of severe endometriosis between the posterior cervical peritoneum and the anterior sigmoid or rectum obliterate the cul-de-sac and distort normal anatomic landmarks. Surgery for endometriosis is associated with severe complications, including ureteral and rectal injuries and voiding dysfunction. Surgeons should recognize the importance of not only avoiding ureteral and rectal injuries but also focusing on the preservation of the hypogastric nerves. Herein, we reported the anatomic highlights and surgical steps of laparoscopic hysterectomy for posterior cul-de-sac obliteration with the nerve-sparing technique.

Automated summary

Severe endometriosis can cause dense adhesions between the posterior cervical peritoneum and the anterior sigmoid or rectum, leading to obliteration of the cul-de-sac and distortion of normal anatomic landmarks. Surgeons should focus on not only avoiding ureteral and rectal injuries, but also preserving the hypogastric nerves to prevent complications. This article reports on the anatomical highlights and surgical steps of laparoscopic hysterectomy for posterior cul-de-sac obliteration with the nerve-sparing technique.