Transvaginal Specimen Extraction: Novel Techniques and Strategies for Success

Abstract

<h3>Study Objective</h3> To review the benefits of transvaginal specimen extraction, to demonstrate applications of this technique in laparoscopic gynecologic surgery, and to discuss strategies for successful transvaginal extraction and colpotomy closure. <h3>Design</h3> Educational video highlighting surgical techniques. <h3>Setting</h3> Academic medical center. <h3>Patients or Participants</h3> We present four cases of patients undergoing transvaginal specimen extraction during laparoscopic gynecologic surgery. <h3>Interventions</h3> Transvaginal specimen extraction performed via colpotomy or through a dilated cervix. <h3>Measurements and Main Results</h3> We present a stepwise approach to making a posterior colpotomy for transvaginal specimen extraction: 1) Identify the uterosacral ligaments and rectum, 2) expose and delineate the colpotomy site, 3) ensure maintenance of pneumoperitoneum, and 4) make an incision no wider than the borders of the uterosacral ligaments, using a judicious amount of energy. We demonstrate multiple applications of this approach using a variety of instruments and energy sources. Additionally, we present a case of transcervical specimen extraction through a dilated cervix following laparoscopic supracervical hysterectomy. <h3>Conclusion</h3> We have demonstrated a variety of techniques and applications for transvaginal specimen extraction. This approach represents a safe and effective alternative to mini-laparotomy or power morcellation.