International Urogynecology Journal

, Volume 29, Issue 8, pp 1223–1225 | Cite as

Entry into the anterior cul-de-sac during vaginal hysterectomy

  • Brian J. Linder
  • John B. Gebhart
IUJ Video


Introduction and hypothesis

We present a video reviewing the key steps involved in safe anterior cul-de-sac entry during vaginal hysterectomy, including tips for troubleshooting difficult cases such as: uterine procidentia, cervical elongation, and multiple prior cesarean sections.


Anterior cul-de-sac entry is a critical step in performing a vaginal hysterectomy. In this video, we review our approach to anterior entry in patients with normal anatomy, followed by a discussion of techniques that may be useful in cases with challenging anatomy. To start, we drain the bladder, set up exposure with Deaver retractors, and make a circumferential incision at the cervicovaginal junction. In cases with normal anatomy, using sharp, followed by broad blunt finger dissection, the vesicocervical space is opened, and the peritoneal reflection is identified and sharply entered. If this is not possible, additional techniques such cystoscopic bladder illumination, posterior entry first, securing pedicles with extraperitoneal ties, or additional sharp dissection may be utilized. With all techniques, proper intraperitoneal entry should be verified by the visualization of small bowel or fat.


This video reviews technical considerations for anterior cul-de-sac entry during vaginal hysterectomy in patients with normal anatomy and provides tips for troubleshooting challenging cases.


Vaginal Hysterectomy Surgery Technique 


Compliance with ethical standards

Conflicts of interest



Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Supplementary material

192_2018_3646_MOESM1_ESM.mp4 (78.8 mb)
ESM 1 (MP4 80676 kb)


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Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Department of UrologyMayo ClinicRochesterUSA
  2. 2.Department of Obstetrics and GynecologyMayo ClinicRochesterUSA

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