Approach to the obliterated anterior Cul-De-Sac during a total laparoscopic hysterectomy

An obliterated anterior cul-de-sac occurs when the vesico-uterine avascular space is absent leading to distortion of normal anatomy. Risk factors include cesarean deliveries, prior pelvic surgeries, infection, and endometriosis. Knowledge of anatomy and good surgical technique is critical to safe completion of a hysterectomy. The laparoscopic approach provides advantages of improved visualization posteriorly, global survey, assistance of the pneumo-peritoneum in plane dissection, and decreased blood loss.
Source: American Journal of Obstetrics and Gynecology - Category: OBGYN Authors: Source Type: research