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Study Objective To review surgical principles that can be used to approach the obliterated anterior cul-de-sac. Additionally, to demonstrate application of these principles during total laparoscopic hysterectomy Design N/A Setting This procedure took place in a hospital-based operating room. Four laparoscopic ports were utilized, including a camera at the umbilicus, right and left lower quadrant ports and a suprapubic port. Patients or Participants The patient is a 46 year old female with complex chronic pelvic pain. Her surgical history included a prior Cesarean delivery. Ultrasound showed small 8 wk uterus with likely adenomyosis Interventions This video demonstrates a laparoscopic management of an obliterated anterior cul-de-sac as performed during total laparoscopic hysterectomy and bilateral salpingectomy. Measurements and Main Results N/A Conclusion Prior cesarean delivery can complicate laparoscopic hysterectomy. However, reliance on sound surgical principles can help ensure success. These include: Isolation and control of blood supply prior to adhesiolysis; Understanding and identifying safe spaces where anatomy is not altered by adhesive disease; Maintaining forward progress; Restoring anatomy |
