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Total laparoscopic hysterectomy with obliterated anterior cul-de-sac Totale laparoskopische Hysterektomie bei obliteriertem vorderen Douglassack Endometriosis may in severe cases lead to obliteration of the anterior and/or posterior cul-de-sacs in the female pelvis. The anterior cul-desac is generally less commonly affected. This type of cases usually presents a challenge for the operating surgeon, whether via open route or through laparoscopy. In this paper, we present an illustrative case and explain our technique for dealing with a scarred and totally obliterated anterior cul-de-sac because of endometriosis during total laparoscopic hysterectomy.