Fig. 2

a A puncture needle for epidural anesthesia connected to a 20 ml syringe inserted through the middle of the vaginal vestibule. b The puncture needle inserted through the gap between the bladder and the rectum toward the peritoneum beyond the fiber cord. c The water cushion formed by injecting physiological saline solution containing pituitrin and epinephrine. The cushion helps to divide the peritoneum at the pelvic floor and rectum. d The vestibule mucosa divided using medium-sized, curved pliers. Then the vaginal tunnel is formed by extending the incision using the clinician’s finger. e A mold inserted through the vaginal tunnel. f The peritoneum at the end of the mold incised using an electric scalpel. The incision is extended by the mold and a larger mold is used to dilate the vaginal tunnel. g The clinician guiding the peritoneum downward using his finger on the incision margin of the peritoneum as a guide toward the vaginal opening by the pliers. h The vaginal opening sutured at four points (3, 6, 9, and 12 o’clock). i A mold being put in the vaginal tunnel and purse-string sutures used to close the pelvic cavity