Ingenuity during total laparoscopic hysterectomy in women with pouch of Douglas adhesions: To avoid rectosigmoid colon injury

Kazutaka Akira, Hideyasu Toyozawa, Daisuke Sakaba, Asumi Misawa, Eri Yoshiizumi, K. Shimada, Masaki Sugiyama
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2022 · vol. 38(1) , pp. 222–227 · doi:10.5180/jsgoe.38.1_222 · W4285176563
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This paper describes a technique for managing pouch of Douglas adhesions during total laparoscopic hysterectomy to prevent rectosigmoid colon injury.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This paper reports a surgical technique intended to prevent rectosigmoid colon injury during total laparoscopic hysterectomy (TLH) in women with suspected or observed pouch of Douglas adhesions. At a single institution, the authors describe a stepwise approach that exposes the cervical fascia, uses a vaginal pipe to facilitate vaginal wall incision and instrumentation, and then grasps and lifts the cervix to create a space between the pouch of Douglas and the posterior vaginal wall, maintaining distance from the rectum/sigmoid colon. They report completing TLH safely without rectosigmoid colon damage when using this method. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Purpose
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Methods

First, we incise the supporting tissue to expose the entire cervical fascia, and insert a vaginal pipe when an incision of the vaginal wall is possible. Next, we incise the ventral vaginal wall and insert the forceps through the hole of the vaginal pipe. Finally, we grasp the cervix at 12 o'clock with the forceps and lift the entire uterus ventrally. This makes a space between the pouch of Douglas and the posterior vaginal wall, which enable us to treat the posterior vaginal wall while maintaining the distance from the rectum/sigmoid colon. Using this method, we can securely lift the entire uterus from the vaginal side to the cranial, thus creating sufficient work space between the posterior uterus and the rectum even in cases with pouch of Douglas adhesions.

Results

We completed the operations safely without any damage due to this ingenuity.

Conclusion

Using this technique, we have been able to prevent rectosigmoid colon injury in cases with pouch of Douglas adhesions at our institution. We hope that this report will encourage more laparoscopists to use this method in cases with pouch of Douglas adhesions observed before or during surgery. © 2022 日本産科婦人科内視鏡学会

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last seen: 2026-06-10T17:14:06.276822+00:00
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