Previous pelvic or abdominal operations generating adhesions. Operations addressing deep endometriosis, adnexal abscesses, peritonitis of any origin, myomectomies, bowel resections, are likely to induce heavy adhesions. It is almost always possible to free the pelvis laparoscopically, but the risk of bowel or bladder injury is much higher. It is sometimes difficult to find the way of the ureters. Please note that previous Cesarean section can be an issue; it may make the bladder dissection more difficult and increases the risk of injury.

Obesity. Fatty tissue infiltrates the peritoneum and makes it difficult to localize and to dissect the promontory. The pararectal fossa is also infiltrated and this tissue is richly vascularized. Blunt dissection may provoke much more bleeding than in normal weighted patients. The mesosigmoid and the mesentery is very thick and heavy and vascularized, making it difficult to push away the bowel. The procedure will require a higher CO₂ pressure (up to 15 mm Hg) and a stronger Trendelenbourg position and your anesthesiologist will be in trouble. Very frequently, obese patients have colic diverticulitis which makes the sigmoid rigid, inflammatory and fragile. If I certainly never would recommend to start your learning curve with obese patients, it is obvious that these women have the best indication for LSCP: laparoscopy is minimal invasive, mesh surgery is always required in these patients who have a very high risk of recurrence and many are diabetic with a high risk of infection after vaginal insertion of the mesh.