Using a clockface as the reference, the anterior colpotomy is initiated at the 12 o'clock position with the monopolar scissors (settings: 30 watts).
The posterior colpotomy is initiated at the 6 o'clock position and extended upward to the 4 o'clock and 8 o'clock positions, stopping to avoid the uterine arteries bilaterally.
Upon reaching the vaginal ring/cup, the circumferential colpotomy is completed at the 3 o'clock and 9 o'clock positions.
Once progress is made to the level of the Koh ring, the vessel sealer is replaced with the scissor and the scissors are used to complete the circumferential colpotomy.
It is imperative for the surgeon or the assistant to constantly push the uterus cephalad using the manipulator in order to protect the ureters from thermal damage as well as transection at the time of colpotomy.
Once the uterine arteries are secured, the colpotomy is begun anteriorly using the active blade of the Harmonic Ace.
The cervix is circumscribed along the colpotomy cup and, once disconnected, is delivered vaginally.
The extirpation method was colpotomy in 143 cases and morcellation in 22.
A total of 824 fibroids were removed via colpotomy and 99 were removed via morcellation.
was performed lateral to the fistula track and the bladder was posteriorly mobilized from the vagina.
in Cincinnati, as part of the Harmonic Scalpel line, in a wide range of operations including laparoscopically assisted vaginal hysterectomy ovarian cystectomy, excision of endometriosis, partial oophorectomy, sacral plexus neurectomy small-bowel adhesiolysis, bladder-flap development, anteroposterior colpotomy
, and laparoscopic appendectomy.