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At least 19 recordsLinked to original sources
PubMed2002

Laparoscopic myomectomy technique. Use of colpotomy and the harmonic scalpel.

OBJECTIVE: To describe the use of colpotomy and the harmonic scalpel in laparoscopic myomectomy and to compare estimated blood loss when using unipolar cautery versus the harmonic scalpel and surgical time for colpotomy versus morcellation. STUDY DESIGN: A retrospective, cohort study was performed on 168 patients who were diagnosed with and treated for uterine leiomyomata between January 1992 and January 2000. Patients presented with infertility, menometrorrhagia, dysmenorrhea, masses on ultrasound or a combination of these symptoms. Two patients required hysterectomy, and 1 required conversion to laparotomy due to bleeding, leaving 165 patients who underwent laparoscopic myomectomy, 143(87%) by colpotomy and 22 (13%) by morcellation. Unipolar cautery was used for uterine incision in 112 of the 165 myomectomies (68%) and the harmonic scalpel in 53 (32%). Surgery was performed at one of two community hospitals in the Seattle area or a general hospital in Taiwan. RESULTS: Mean estimated blood loss using the harmonic scalpel (243 mL, range 150-350) was significantly less (P < .01) than that using unipolar cautery (378 mL, range 203-800) for uterine incision. Mean surgical time for colpotomy (144 minutes, range 110-260) was less (P < .05) than that for morcellation (168 minutes, range 140-244) despite having removed a larger median number of myomata per patient of comparable or larger size (seven by colpotomy versus four by morcellation). CONCLUSION: These data suggest that the harmonic scalpel is effective for uterine incision during myomectomy and may result in less bleeding than unipolar cautery while offering some advantages in safety. Multiple leiomyomata can generally be extracted more quickly via posterior colpotomy than by morcellation. This difference is smaller and therefore less important in patients with only a few small to medium-sized (< 10 cm) fibroids. For these patients, the minimal invasiveness of morcellation may offer a more significant benefit.

Adolescent↗
PubMed1996

Laparoscopically assisted colpotomy with the Pelosi illuminator and Visiport trocar system.

OBJECTIVE: To describe a technique for laparoscopically assisted colpotomy. STUDY DESIGN: The Pelosi endoscopic illuminator and Visiport trocar system were combined to perform visually guided transvaginal colpotomy. Thirty-five consecutive laparoscopic gynecologic cases necessitating cul-de-sac entry were approached with this technique. RESULTS: The technique was performed successfully in all 35 cases without complications or technical difficulties and with an average colpotomy time of 3.5 minutes. Indications for colpotomy included removal of laparoscopic supracervical hysterectomy specimens, myomata, large adnexal cysts and large tubal pregnancy. CONCLUSION: This colpotomy technique is quick, efficient and easy to perform. Advantages include retention of pneumoperitoneum, facilitated transvaginal insertion of instrumentation to remove pelvic masses, avoidance of an electrosurgical or laser incision, and complete visual control, which minimizes the possibility of traumatic injury to bowel and other pelvic structures.

Colposcopes↗
PubMed1996

A comparative study of laparoscopy and colpotomy for the removal of ovarian dermoid cysts.

OBJECTIVE: To compare laparoscope-assisted transvaginal removal of dermoid cysts to more standard laparoscopic cystectomy techniques. METHODS: We conducted a retrospective review of 44 laparoscopic dermoid removals performed at Olive View-UCLA Medical Center between 1992 and 1995. Cases were divided into three groups based on surgical approach: 1) conventional laparoscopic ovarian cystectomy, 2) laparoscopic ovarian cystectomy and removal of the freed mass via colpotomy, and 3) laparoscopic inspection, then transvaginal cystectomy via colpotomy. Surgical time, estimated blood loss, cyst spillage, and complications were compared. RESULTS: There were 11-19 patients in each group. The groups were similar in patient age, parity, and weight. Larger cysts tended to be removed by the laparoscopy-colpotomy techniques (mean diameter 10 cm) rather than by the purely laparoscopic approach (mean diameter 7 cm, P < .05). Cyst spillage occurred less often (43%, P < .05) and surgical time was shortest (mean 81 minutes, P < .05) with laparoscope-assisted transvaginal ovarian cystectomy compared with conventional laparoscopic techniques. Disposable laparoscopic instruments were used less often with transvaginal cystectomy (7%) than with conventional laparoscopic cystectomy (77%, P < .01). The difference in mean estimated blood loss in the cases using colpotomy (89 mL) compared with cases that did not (65 mL) was not statistically significant. Among the three groups, there were four major operative complications related to blood loss and infection. CONCLUSION: Laparoscope-assisted transvaginal ovarian cystectomy allows the removal of larger dermoid cysts, with less cyst spillage and savings in operative time and equipment compared with conventional laparoscopic cystectomy.

Adult↗
PubMed1982

Diffuse peritoneal sepsis associated with colpotomy drainage of pelvic abscess.

The incidence of and mortality from diffuse peritoneal sepsis associated with the vaginal drainage of pelvic abscesses were retrospectively studied at two hospitals. During the 16-year period from 1961 through 1977 at the University of Mississippi Medical Center, 50 patients underwent colpotomy drainage of pelvic abscesses, diffuse peritoneal sepsis occurred in 5 cases (10%), and 2 of these 5 patients died (40%). During the five-year period from 1972 through 1976 at Baragwanath Hospital, 298 patients underwent colpotomy drainage of pelvic abscess, diffuse peritoneal spesis occurred in 18 cases (6%), and 4 of these 18 patients died (22%). By combining the two series, a total of 348 cases of colpotomy drainage yielded 23 instances of diffuse peritoneal sepsis (6.5%0, with six deaths attributable to this condition (26%). The overall mortality for the 348 cases was 2% (seven deaths), and diffuse peritoneal sepsis was the cause of six of the seven fatalities. It is concluded that colpotomy drainage of pelvic abscesses is a safe and most effective procedure provided that the cases are well selected and the postoperative course is closely followed. Neglect of these basic principles may result in the development of diffuse peritoneal sepsis in a small but important group of patients.

Abscess↗
PubMed1989

Transabdominal laser colpotomy.

Transabdominal laser colpotomy was performed on 26 women for the removal of sizable pathologic specimens obtained through extensive operative laparoscopy. We used CO2 lasers operated at 10-30 W with a continuous wave. The colpotomy incision was cut across ring forceps that were then used to retrieve and remove the specimens vaginally under laparoscopic control. Colpotomy was found to be safe and not to increase morbidity in extensive laparoscopy.

Female↗
PubMed1994

[Colpotomy for specimen removal in laparoscopic surgery].

The removal of the specimen is one of the major problems in laparoscopic colon surgery. In two female patients we have found a solution in the colpotomy. It is easy to perform and hardly recognized by the patient. Other large specimen as a kidney or spleen can also be removed this way. An elongation of an incision in the abdominal wall can be avoided. The pneumoperitoneum is preserved by a special clamp for the extraction via colpotomy. The removal of a specimen via colpotomy is a conclusive step towards, minimal invasive surgery'.

Adult↗
PubMed1979

Tubal ligation by colpotomy incision.

A five-year review of colpotomy tubal ligation performed on 585 patients within a private-practice setting in Columbus, Georgia, is analyzed. Operative time averaged under 30 minutes, and average hospital stay was less than 3 days. The major postoperative complication rate was less than 2%. The patient population is reviewed as to age, parity, previous contraception, and medical indications for sterilization. Surgical technique is discussed, and several suggestions are made, A follow-up of subsequent gynecologic procedures and the interval following colpotomy is then presented.

Adolescent↗
PubMed1993

Adhesion formation after endoscopic posterior colpotomy.

Twenty-two women who had undergone laparoscopic posterior colpotomy at initial operative laparoscopy and later underwent a second laparoscopic procedure were evaluated for adhesion formation. Fifteen women (68%) had myomata removed, 3 (14%) had a dermoid cystectomy, 1 (5%) had a serous cystadenoma removed, and 3 (14%) who had large endometriomata and severe adhesions underwent salpingo-oophorectomy. Although filmy adhesions were noted in nine women, no adhesions were noted in the cul-de-sac. Based on our limited results, it does not appear that tissue removal via laparoscopic colpotomy predisposes reproductive-age women to postoperative adnexal adhesion formation.

Adnexal Diseases↗
PubMed1993

Laparoscopic trocar-assisted colpotomy.

Trocar-assisted transvaginal colpotomy was performed in 17 patients to remove large pathologic specimens during laparoscopic operations when the specimen could not be extirpated through the laparoscopic ports. Under direct laparoscopic visualization, colpotomy was performed using a 10- or 11-mm disposable trocar without the sleeve. The trocar was removed, a ring forceps was placed through the incision, the incision was enlarged, and the mass was grasped with the ring forceps and removed. This technique is safe, fast, and easy to perform. In addition, smoke is not created and potential electrocautery damage to pelvic structures is avoided.

Female↗
PubMed1999

Hysterotomy by a colpotomy approach for treatment of foetal mummification in a cow.

A 7-year-old Brahman cow was diagnosed as suffering from chronic foetal mummification of unknown aetiology, concurrent cystic ovarian disease, prolapse of the 2nd cervical ring and chronic cervicitis. Repeated treatment with prostaglandin F2alpha and oestrogen failed to resolve the mummification. A hysterotomy was performed via an incision in the dorsolateral vaginal wall. Good exposure of the uterine horn was achieved and mild post-operative complications were observed. Colpotomy can be regarded as an alternative surgical approach to the moderately enlarged bovine uterus.

Animals↗
PubMed1994

A new approach to hysterectomy without colpotomy: pelviscopic intrafascial hysterectomy.

OBJECTIVE: Total abdominal and vaginal hysterectomies have been performed by extrafascial enucleation of the uterus with amputation of the upper vagina. Our new method, which is limited to an intrafascial cylindriform enucleation of the cervix, leaves intact the highly vascularized extrafascial cervical tissue, the corresponding nerves, and the topography of the ureters. STUDY DESIGN: From December 1991 to December 1992, 60 patients underwent an intrafascial hysterectomy by pelviscopy and two patients by laparotomy for leiomyomas, endometriosis, and other intractable bleeding disorders and for a variety of additional benign gynecologic diseases. Uterine extirpation was performed in the classic manner with grasping forceps, scissors, ligatures, and sutures. No electrosurgical equipment, stapling devices, or lasers were used. RESULTS: We analyzed our cases according to intraoperative, immediate postoperative, and late postoperative complications. We had no major complications. Average operating time is compatible with that of conventional total abdominal or vaginal and laparoscopy-assisted vaginal hysterectomy. Blood loss was minimal (average drop of hemoglobin 1.8 gm). Average hospitalization was 50.6 hours. CONCLUSION: There has never been an indication for the removal of the normal cervix at hysterectomy, other than for cancer prophylaxis. The synthesis of supracervical extirpation of the uterus, conization of the cervix, and operative laparoscopy (pelviscopy) enables us to perform a truly laparoscopic hysterectomy without colpotomy. Pelvic floor support is maintained and transvaginal sexual sensation is less likely to be impaired because of the preservation of the cardinal and uterosacral ligaments. With the serrated-edge macromorcellator, morcellated cylinders of cervical and uterine body tissue guarantee a thorough histologic examination and interpretation. Physical stress to the patient is minimized. There are no abdominal or vaginal incisions. The abdominal space remains practically unopened. Pelviscopic intrafascial hysterectomy equates with minimally invasive and organ-preserving surgery. It may be sufficient for cervical and endometrial cancer prophylaxis.

Adult↗
PubMed1976

Vaginal hysterectomy by an anterior colpotomy technic.

A simple, relatively unknown technic of vaginal hysterectomy using the anterior colpotomy approach is presented. Experience with this procedure at a small Naval hospital is described. Morbidity occurred in 6.6% of the patients. The advantages of this method of vaginal hysterectomy are summarized.

Adult↗
PubMed1983

Colpotomy drainage of pelvic abscesses.

Retrospectively the records of 155 patients with an acute pelvic abscess who were treated by colpotomy drainage were studied. The more aggressive management, i.e. surgery, is to be preferred and the vaginal approach gives good results. The complications and morbidity in this series were very low and the mortality less than 1%. The procedure itself is simple and requires no special skill or great experience.

Abscess↗
PubMed1992

Ovariectomy by colpotomy in cows.

For the purpose of collecting active ovarian structures for cell culture, unilateral ovariectomy (n = 34 ovaries) was performed per vagina on 17 dairy cows having normal estrous cycles, bilateral ovariectomy was performed on 9 (n = 18 ovaries) dairy cows, and corpora lutea (n = 13) were removed from 11 beef cows having normal estrous cycles. None of the cows was clinically ill after the operation. Nine of 37 cows developed adhesions of both uterine horns and the body of the uterus. Three instruments were used to perform colpotomy. The described surgical technique for removal of the ovaries or corpora lutea is practical and inexpensive, and has low morbidity associated with it.

Animals↗
PubMed1988

Laparoscopic and vaginal colpotomy for the excision of infiltrating cul-de-sac endometriosis.

Palpable endometriotic nodules deep in the cul-de-sac and vagina represent the extension of intraperitoneal disease. Although such nodules used to be excised with vaginal colpotomy and by tracing the endometriosis to the peritoneum, the dissection of these lesions under laparoscopic visualization had aided in their removal. Of seven patients who were approached with a plan for combined laparoscopic and vaginal excision, five underwent the procedure. The last two required laparotomy due to bowel muscularis involvement.

Douglas' Pouch↗
PubMed1993

Effects of bilateral ovariectomy via colpotomy in mares: 23 cases (1984-1990).

Postoperative performance and behavioral patterns were investigated retrospectively in 23 client-owned mares after bilateral ovariectomy via colpotomy. The interval from surgery to postoperative inquiries ranged from 9 to 67 months. Information obtained from review of the medical record and client interviews included the reason for ovariectomy, postoperative complications, problems identified by owners after discharge of the mare from the hospital, postoperative level of athletic performance, postoperative signs of estrus, and overall owner satisfaction. Reasons given by owners for having mares ovariectomized were behavioral modification (16 mares), use as embryo-transfer recipients (3 mares), use as mount mares for collecting semen (2 mares), elimination of chronic colic during estrus (1 mare), and sterilization for registration (1 mare). Postoperative complications developed in 4% (1/23) of the mares; however, problems were noticed by the owners of 4 other mares after discharge from the hospital. Continuing signs of behavioral estrus were detected in 35% (8/23) of the mares, but in only in 9% (2/23) was the behavior judged to be objectionable by the owner. Of 12 mares used in performance events prior to bilateral ovariectomy, 10 were judged to be competing at greater than preoperative levels, 1 was judged to be competing at the same level, and 1 was judged to be competing at less than preoperative level of performance. Of 18 owners, 14 were satisfied, 2 were undecided, and 2 were dissatisfied with their mare after it had had bilateral ovariectomy.

Animals↗
PubMed1976

Colpotomy drainage of pelvic abscess.

Sixty-five patients who had a pelvic abscess drained by colpotomy or rectal incision were studied. The minority of the patients (28) developed the abscess after a hospital-acquired infection (Group I) while the other 37 patients developed the abscess after a community-acquired infection (Group II). Except for those patients who developed an abscess after hysterectomy, about one-third of the patients in both groups required a subsequent major operative procedure because of residual infection or symptoms. Of the 40 patients in whom there was a possibility of conceiving following the drainage procedure, 4 (10%) conceived at a later date.

Abscess↗