A Simple Approach to Specimen Retrieval via Posterior Colpotomy Incision

Abstract

Introduction:Posterior colpotomy incision for specimen retrieval is infrequently used in gynecologic laparoscopic surgery unless a concomitant hysterectomy is performed. We aim to describe a simple and unique technique for creating the colpotomy incision and to describe intraoperative and postoperative outcomes.Methods:Fifty patients underwent adnexal specimen retrieval through a posterior colpotomy incision. After devascularization and detachment of the adnexal specimen, the posterior cul-de-sac was visualized. The colpotomy incision was created by introducing a 12- or 15-mm laparoscopic trocar through the vagina into the posterior vaginal fornix under direct visualization. Specimens were placed into laparoscopic bags and removed through the vagina. The colpotomy incision was closed vaginally. Charts were reviewed for intraoperative and postoperative outcomes.Results:Twenty-nine women underwent adnexal surgery for an adnexal mass, 14 women underwent surgery for pelvic pain, and 7 women underwent adnexal surgery for primary prevention of malignancy. The specimens removed ranged in size from 2 to 16 cm (mean 5.7). The mean time patients were under anesthesia was 103 minutes (SD 57.3). There were no operative complications related to the colpotomy incision and no cases of postoperative vaginal cellulitis or pelvic infection were reported. Only 1 woman with a prior vaginal delivery reported dyspareunia postoperatively.Conclusion:This simple technique for posterior colpotomy incision can easily be added to the gynecologic surgeon's armamentarium and can be safely used for most women.

Hybrid Transvaginal NOTES and Mini-Laparoscopic Colectomy: Benefit Through Synergy

“…Because of the elasticity of the vagina, successful transvaginal extraction of specimens up to 19 cm in size have been reported in the literature—commonly up to 10 cm diameter, via posterior colpotomy. 9,14,15 Transvaginal NOTES appears to be the most advantageous route for colonic resections where transanal extraction would require a separate rectal colotomy, particularly for right hemicolectomy (or extended right hemicolectomy) and including limited resections in this territory.…”

“…In all cases, transvaginal access was achieved by the method described by Clark et al 9 The posterior lip of the cervix was grasped with a Teale-Vulsellum (INKA Surgical Instruments, Jandakot, Western Australia) forceps and retracted anteriorly. Two 0 Vicryl (Ethicon, Somerville, New Jersey, USA) stay sutures were placed in the posterior fornix at either end of the wound, using a Finochietto needle holder which aided in visualization and closure.…”

A Novel Approach to Combined Vaginal and Laparoscopic Gynecological Surgery

“…Moreover, several studies have been published recently demonstrating the use of a posterior colpotomy incision to remove specimens during benign gynecologic surgery. 3–6 As these studies have demonstrated, traditional removal of gynecologic specimens had included an extension of one of the laparoscopic port sites. However, with specimen removal through a posterior colpotomy, extension of laparoscopic incisions can be avoided for faster wound healing, less pain and better cosmesis.…”

Seguridad de la extracción de masas pélvicas por colpotomía en mujeres llevadas a laparoscopia ginecológica en el Hospital de San José de Bogotá, Colombia, 2016

“…It is worth remembering that the laparoscopic technique must be safe for the patient, minimise the risk of abdominal contamination, and allow for the adequate pathology study of the specimen. Consequently, colpotomy could be an option for the removal of moderate-sized masses (5,9,10).…”

“…Colpotomy consists of performing an opening in the posterior vaginal cul-de-sac by means of an incision at the level of the uterosacral ligaments using monopolar energy. The idea is to use the vagina as a natural orifice for removing pathology specimens of varying sizes (6,10). However, it is used infrequently given that there are other electrical or manual morcellation techniques that can be used to reduce the size of the specimens.…”