(2) The use of monopolar cautery for colpotomy
and different closure techniques may account for these differences.
Electrosurgery typically is used for creation of the colpotomy
in laparoscopic and robotic hysterectomy, and thermal damage at the cuff could lead to poor healing.
Specimen retrieval is done in all cases either through the 10mm port or by colpotomy
. We do not use the endobag routinely.
In this article, we describe contained transvaginai tissue extraction through a posterior colpotomy
in the setting of laparoscopic myomectomy, describing an actual case.
Another alternative is extracting myoma and other tissues through a posterior colpotomy
. Rates of dyspareunia and adhesions in the cul-de-sac after tissue extraction through a colpotomy
are low (J.
The particular methods for specimen removal demonstrated include through the colpotomy
for TLH and cold knife manual morcellation within a bag using an Alexis retractor for LSH.
Leiomyomas could be removed intact through a colpotomy
or through a small abdominal incision.
Delivery through the vagina or colpotomy
during vaginal or laparoscopic hysterectomy uses the technique of coring, which has long been established in our field.
He or she must know not only how to turn the uterus for vessel coagulation and visualization of anatomy, but also the nuances of traction and countertraction for dissection and the colpotomy
. Various uterine manipulators will work; I prefer the VCare uterine manipulator.
In addition, because the size of the specimen frequently is too large to remove through a colpotomy
intact, I morcellate the uterus manually with a scalpel using coring, wedge resection, and myomectomy.
For total laparoscopic hysterectomy, however, a uterine manipulator can be helpful for the colpotomy
. Late placement of the manipulator in these cases--after the lateral attachments are dissected and before colpotomy
is performed--works perfectly.
Next month we continue our series on surgical techniques with a video on why choosing the proper colpotomy
cup is critical for successful minimally invasive hysterectomy.