This is the fourth article in the series of articles unfolding avascular spaces of the pelvis. Authors recommend reading the series of articles starting from "Drive safely through the pelvis -know your pelvic roads: Retropubic space of Retzius" published in the Sri Lanka Journal of Obstetrics and Gynaecololgy 1 .

Bladder endometriosis is uncommon yet a cause of cyclical disabling urinary symptoms. Surgical excision of the bladder endometriotic nodule using combined cystoscopic and laparoscopic approach ("light to light technique") remains the best approach where surgery is deemed the mode of treatment. A 31-year-old infertile woman underwent resection of endometriosis of the bladder by this method. The main surgical steps included ureteric stenting, bladder mobilization, marking the endometriotic nodule cystoscopically, cystoscopic transillumination, completion of the bladder nodule excision laparoscopically and bladder repair.

There is a global trend to move towards laparoscopic surgery in hysterectomies. We describe our experience in initiating laparoscopic hysterectomy in this article. We conducted 21 laparoscopic hysterectomies from February 2016 to January 2017 with one case needing conversion to vaginal hysterectomy. The mean time taken for surgery was 85.6 minutes and the range was from 60 minutes to 121 minutes. The mean drop of haemoglobin following surgery was 0.71g/dL. One patient developed acute retention of urine and one suffered a urinary tract infection following surgery. No surgical complications were noted. We conclude that despite initial difficulties, laparoscopic hysterectomies could be carried out in centers with reasonable facilities.

No abstract