This Video is Level 4 To perform at this level, the surgeon should be acquainted with all instruments, have advanced hand-to-eye coordination, recognize the dangers, start focusing on hemostatic principles and safety techniques and be able to operate without supervision. In last week’s video, we showed a straightforward technique for a total laparoscopic hysterectomy (TLH) with sacroiliac ligament (SIL) vaginal suspension in a woman with a second degree uterine prolapse and a cystocele. Today, we will demonstrate a similar method in a patient with severe large bowel adhesions and pelvic inflammation due to large bowel diverticulitis. Case The patient is a 62-year-old woman with two previous cesarian sections, an appendectomy and a long standing history of pelvic pain due to large bowel diverticulitis treated with IV antibiotics. She had a failed colonoscopy due to narrowing of the sigmoid lumen as a result of adhesions and inflammation.