LAUSR

Video Objective This video describes a systematic stepwise approach for vaginal cuff revision associated with vaginal cuff endometriosis and rectovaginal disease. Setting 39 year-old presented with persistent cyclic vaginal bleeding, pelvic pain and deep dyspareunia following laparoscopic hysterectomy. She was noted to have a 2 cm vaginal cuff nodule with posterior cul de sac obliteration. The patient failed medical management and desired surgical management. Interventions Laparoscopic vaginal cuff revision was performed using a systematic approach with bilateral ureterolysis, excision of uterosacral ligament fibrosis, opening the rectovaginal space, shaving of rectal endometriosis and resection of the vaginal cuff nodule. Conclusion This stepwise approach for vaginal cuff revision in patients with symptomatic rectovaginal endometriosis provides a roadmap for the effective and safe excision of vaginal cuff nodules, while minimizing the risks of injury to the bladder, the ureters, the rectum and the risk of vaginal cuff dehiscence, persistent dyspareunia and recurrent endometriosis.