A surgical window to access the obliterated posterior cul-de-sac at vaginal hysterectomy

Objective: To perform vaginal hysterectomy and adnexectomy without laparoscopic assistance in women with ovarian endometriosis by accessing the posterior cul-de-sac via the posterior uterocervical-broad ligament space. Method: The author identified the posterior uterocervical-broad ligament space as a surgical window while reviewing his experience at accessing the pouch of Douglas in 40 women in whom vaginal hysterectomy without laparoscopic assistance was performed for ovarian endometriosis. He then used this window in 102 women to remove the adnexa vaginally during vaginal hysterectomy, also without laparoscopy. Results: This new technique was successful in 98 women, with no major complications. but 4 of the first 50 required laparotomy to complete the surgery. Conclusion: This new approach allows experienced surgeons to treat women with endometrial ovarian cysts by removing the adnexa vaginally during vaginal hysterectomy without laparoscopy, and complete the surgery abdominally or laparoscopically when necessary. (C) 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All tights reserved.