Posterior colpotomy revisited: a forgotten route for retrieving larger benign ovarian lesions following laparoscopic excision

Abstract

Although simple, ovarian cysts can be decompressed (within an impermeable pouch) following laparoscopic excision to allow lesions of up to 10 cm to be delivered safely. It is more difficult to remove solid or semi-solid ovarian tumours (such as fibromas and dermoid cysts) through this route. We present a modification of laparoscopic-assisted transvaginal retrieval of ovarian tumours through a posterior colpotomy incision (in a bag) and suggest that this is a route that allows large specimens to be retrieved safely and with minimal spillage. Women with solid or semi-solid ovarian cysts of greater than 5 cm, undergoing operative laparoscopy, were offered the option of having the specimens delivered through a posterior colpotomy, if retrieval through the abdominal ports proved difficult. The median specimen diameter was 6 cm (range 4-8 cm) and the median blood loss was 200 ml (range 150-250 ml). The median operating time was 50 min (range 40-90 min) with most patients being discharged within 24 h (median 18 h; range 16-21 h). There was no inadvertent spillage of cyst content or any intra or post-operative complications. Laparoscopic-assisted transvaginal removal of these lesions (in a bag!) allows large specimens to be removed securely and with minimal spillage.