Laparoscopic modified radical hysterectomy for women with stage IV AFS endometriosis and obliterated Douglas space: a technical note (with video)
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This technical note describes a nine-step laparoscopic modified radical hysterectomy procedure for women with stage IV endometriosis and an obliterated Douglas space, detailing dissections and rectal management options.
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Abstract
Excision of deep infiltrating endometriosis has to be complete to prevent symptomatic recurrences but with more complications. The patients with obliterated Douglas space who wish a definitive treatment for their pain require a more complex hysterectomy to remove all the lesions. Laparoscopic modified radical hysterectomy may allow to perform safely this surgery following 9 steps. The dissection is standardized according to anatomical landmarks. The key steps are: extrafascial dissection of uterine pedicle by opening the pararectal spaces and paravesical space, nerve sparing, ureterolysis if needed, the retrograde dissection of rectovaginal space and the rectal step if needed. The rectal step depends on depth of rectal infiltration and on the number of nodules (rectal shaving, disc excision or rectal resection). This standardized procedure could help surgeons to achieve a complex radical surgery for patients with endometriosis and obliterated Douglas space.
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Too few in-corpus citations on either side for a chart; here are the lists.
Cites (4)
- Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection 2001
- Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series 2016
- Does the learning curve of conservative laparoscopic surgery in women with rectovaginal endometriosis impair the recurrence rate? 2008
- Comparison of Laparoscopic Hysterectomy in Patients with Endometriosis with and without an Obliterated Cul-de-sac 2019
References (8)
- Comparison of Laparoscopic Hysterectomy in Patients with Endometriosis with and without an Obliterated Cul-de-sac via openalex
- Does the learning curve of conservative laparoscopic surgery in women with rectovaginal endometriosis impair the recurrence rate? via openalex
- Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection via openalex
- Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series via openalex
- W2159135895 via openalex
- W2942525018 via openalex
- W3046264013 via openalex
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Source provenance
- europepmc
- last seen: 2026-08-14T06:11:53.302379+00:00
- openalex
- last seen: 2026-06-10T17:14:06.276822+00:00
- pubmed
- last seen: 2026-08-14T06:11:20.328755+00:00
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