Dense adhesions because of severe endometriosis between the posterior cervical peritoneum and the anterior sigmoid or rectum obliterate the cul-de-sac and distort normal anatomic landmarks. Surgery for endometriosis is associated with severe complications, including ureteral and rectal injuries and voiding dysfunction. Surgeons should recognize the importance of not only avoiding ureteral and rectal injuries but also focusing on the preservation of the hypogastric nerves. Herein, we reported the anatomic highlights and surgical steps of laparoscopic hysterectomy for posterior cul-de-sac obliteration with the nerve-sparing technique.
Keywords: cul-de-sac obliteration; deep endometriosis; frozen pelvis; nerve sparing; obliterated posterior cul-de-sac; pararectal space; pouch of Douglas obliteration; total laparoscopic hysterectomy.
Copyright © 2023 Elsevier Inc. All rights reserved.