Posterior Colpotomy: A Less Invasive Option for Tissue Extraction

Abstract

<h3>Study Objective</h3> To review critical steps of specimen extraction through a posterior colpotomy during laparoscopic and robotic myomectomy. <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> Power morcellation was the primary method of removing larger specimens without performing a mini-laparotomy for minimally invasive gynecologic surgery until 2014. This changed when the FDA placed restrictions due to concern for the spread of unsuspected cancer cells with power morcellators. Gynecologic surgeons have since been required to search for the best methods to remove large specimens, such as leiomyomas, in safe and efficient ways. One technique is the use of posterior colpotomy for removal of specimens up to 10 cm in size to avoid performing a laparotomy or mini-laparotomy. <h3>Patients or Participants</h3> The first case demonstrates a patient with a 6 cm pedunculated fibroid removed laparoscopically. The second case depicts a patient with a symptomatic fibroid uterus, the largest fibroid 9 cm in diameter. All specimens are removed via posterior colpotomy within containment bag. <h3>Interventions</h3> This video demonstrates how to identify key anatomic landmarks for safe colpotomy creation during laparoscopic and robotic surgery. Tips for extracting larger specimens are covered with review of important aspects of colpotomy closure. <h3>Measurements and Main Results</h3> Both patients did well postoperatively with resolution of symptoms and no complications. Specimens were removed intact with no issues related to creation of colpotomy. <h3>Conclusion</h3> Minimally invasive gynecologic surgery has proven benefits over laparotomy but creates the challenge of safe and efficient specimen extraction. Use of a posterior colpotomy, either robotically or laparoscopically, allows for maintenance of small skin incisions and efficient removal of an intact, contained, solid specimens up to 10cm in size. This technique is demonstrated via myomectomy and removal of leiomyoma but can be applied to safe removal of other types of large intra-abdominal specimens.