To describe the anatomical borders of the rectovaginal space and provide a stepwise approach to opening the rectovaginal space via laparoscopy with and without robotic assistance.

Design: Educational video

Setting: Tertiary care academic center

Patients or Participants: NA

Interventions: Dissection of the rectovaginal space may be necessary to facilitate certain gynecological procedures and avoid inadvertent injury to rectum, ureters, and vagina. In this video, we describe a stepwise approach to rectovaginal dissection including: (1) Dissection of the medial pararectal space, lateral to the uterosacral ligaments and medial to the ureter (2) Undermining the rectovaginal peritoneum using lateral to medial push-and-spread, blunt dissection (3) Making a transverse peritoneal incision on the posterior cervix to enter the rectovaginal space superiorly (4) Separating the rectum from the rectovaginal peritoneum by applying proper traction and judicious use of electrosurgery (5) Transecting the peritoneum with appropriate margins. We demonstrate the application of these steps with live surgical footage in both conventional laparoscopy and robotic-assisted laparoscopy. This stepwise approach can be applied to a variety of gynecological procedures and the order of these steps can be individualized to suit patient anatomy and pathology.

Measurements and Main Results: NA

Conclusion: A stepwise approach to rectovaginal dissection helps to improve efficiency, safety, and reproducibility even in cases with advanced pathology.