AI Article Synopsis
- Surgery for severe endometriosis can lead to complications like injuries to the ureter, rectum, and dysfunction with urination, making careful anatomical mapping critical.
- The technique for total laparoscopic hysterectomy involves five steps: preparing the area, developing spaces to identify and isolate the ureter, and reopening the pouch of Douglas.
- Emphasizing precise anatomical landmarks during surgery helps reduce risks of complications, and each step should be consistent for safety and efficacy.
Article Abstract
Background: Dense adhesion due to severe endometriosis between the posterior cervical peritoneum and the anterior sigmoid or rectum obliterates the cul-de-sac and distorts normal anatomic landmarks. Surgery for endometriosis is associated with severe complications, including ureteral and rectal injuries, as well as voiding dysfunction. It is important to develop the retroperitoneal avascular space based on precise anatomical landmarks to minimize the risk of ureteral, rectal, and hypogastric nerve injuries. We herein report the anatomical highlights and standardized and reproducible surgical steps of total laparoscopic hysterectomy for posterior cul-de-sac obliteration.
Operative Technique: We approach the patient with posterior cul-de-sac obliteration using the following five steps. Step 1: Preparation (Mobilization of the sigmoid colon and bladder separation from the uterus). Step 2: Development of the lateral pararectal space and identification of the ureter. Step 3: Isolation of the ureter. Step 4: Development of the medial pararectal space and separation of the hypogastric nerve plane. Step 5: Reopening of the pouch of Douglas.
Conclusion: Surgeons should recognize the importance of developing the retroperitoneal avascular space based on precise anatomical landmarks, and each surgical step must be reproducible.
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| http://dx.doi.org/10.1007/s00404-024-07614-y | DOI Listing |
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