Laparoscopic or robotic procedures involving extensive dissection of the posterior cul-de-sac and pelvic sidewalls often require the surgeon and assistants to manipulate the uterus and adnexa to optimize intraoperative visualization and access pathology. This is especially true during excision of endometriosis surgeries. Temporary oophoropexy and uteropexy improve intraoperative visualization and decrease the necessity for additional ports and surgical assistants. These procedures can be efficiently completed by using a Keith needle and suture passed suprapubically (uteropexy) or through the bilateral lower quadrants (oophoropexy) ( Figure ), through the target viscera, and back through the abdominal wall. The suture is then secured at the level of the abdominal wall. A video was included to describe and demonstrate these procedures. Temporary oophoropexy and uteropexy free the assistant to provide countertraction, irrigation, and removal of specimens rather than limiting the assistant to the sole duty of retraction. This can in turn improve operating room efficiency and safety.
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Excision of pathology involving the posterior cul-de-sac and pelvic sidewalls frequently requires manipulation of the uterus and adnexa to optimize visualization and to safely complete the procedure. Temporary oophoropexy and uteropexy may be useful in cases of endometriosis, in particular deeply infiltrating disease involving the posterior broad ligament and uterosacral ligaments, requiring ureterolysis and parametrial dissection.