Total laparoscopic hysterectomy with obliterated anterior cul-de-sac

M Sami Walid, Richard L Heaton
German medical science : GMS e-journal · 2010 · vol. 8 , pp. Doc03 · doi:10.3205/000092 · PMID:20200656 · W100705807
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This paper presents a technique for total laparoscopic hysterectomy in a case of endometriosis causing complete obliteration of the anterior cul-de-sac.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper describes an illustrative 42-year-old patient undergoing total laparoscopic hysterectomy and salpingo-oophorectomy for suspected ovarian pathology, in whom severe endometriosis resulted in an obliterated anterior cul-de-sac with the uterus adherent to the bladder reflection and extensive fibrotic parametrial disease, along with other pelvic adhesions. Using a stepwise laparoscopic approach based on ureter identification, lateral-to-medial dissection, management of parametrial bleeding by locating the uterine artery lateral to the ureter, and careful bladder dissection with the harmonic device, the authors report successful completion without complications; pathology confirmed endometriosis and no malignancy. The paper explicitly frames its contribution as a technique description supported by experience rather than a comparative study, and it is limited by being a single case report with no generalizable outcomes data. This paper is centrally about endometriosis — specifically a technique for reopening a scarred, totally obliterated anterior cul-de-sac during total laparoscopic hysterectomy.

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Abstract

Endometriosis may in severe cases lead to obliteration of the anterior and/or posterior cul-de-sacs in the female pelvis. The anterior cul-de-sac 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.

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Douglas' Pouch Endometriosis Hysterectomy Laparoscopy Adult Cicatrix Cicatrix Cicatrix Douglas' Pouch Douglas' Pouch Endometriosis Endometriosis Female Humans Hysterectomy Laparoscopy Severity of Illness Index

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (11)

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