Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 13 , ISSUE 1 ( January-February, 2021 ) > List of Articles


Techniques for completing Colpotomy without Uterine Manipulator in a Total Laparoscopic Hysterectomy

Shazia Khan, Kuan-Gen Huang, Ala U’wais

Keywords : Colpotomy, Total laparoscopic hysterectomy, Uterine manipulator

Citation Information : Khan S, Huang K, U’wais A. Techniques for completing Colpotomy without Uterine Manipulator in a Total Laparoscopic Hysterectomy. J South Asian Feder Obs Gynae 2021; 13 (1):74-76.

DOI: 10.5005/jp-journals-10006-1853

License: CC BY-NC 4.0

Published Online: 00-02-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Aim: To describe techniques used in our setup as an aide to completion of colpotomy in total laparoscopic hysterectomy (TLH), in situations where usage of a uterine manipulator is not feasible. Background: Over the years, various uterine manipulators have flooded the markets to make the step of colpotomy easier. But there are certain conditions that render the usage of manipulators impossible like narrow vagina, virgin women, retracted or pulled up cervix, and non availability of advance manipulators due to financial constraints. Performing TLH in these conditions is challenging, and certain technical innovations aid in ensuring safe completion of the surgery. Technique: We describe the techniques utilizing a gauze on the sponge holder to delineate the cervicovaginal junction. The anterior approach, posterior approach, approach through uterosacral ligament, and cardinal ligament are described for completion of colpotomy. Conclusion: In situations where the application of vaginal manipulators is not feasible, certain technical modifications and varying approaches to the cervicovaginal junction can aid in the successful completion of colpotomy in TLH. Clinical significance: Vaginal manipulator is a useful instrument in laparoscopic hysterectomy. It manipulates the uterus in cephalad, lateral, and anteroposterior directions, making surgical steps in laparoscopic hysterectomy easier and quicker to perform. Its vital role in safely delineating anatomical landmarks like a uterocervical junction, uterosacral ligaments, and ureter cannot be denied. However, there are certain circumstances where the vaginal route is not accessible, and insertion of a uterine manipulator becomes impossible. In these circumstances, the surgeon should know the other options that help in opening the cervicovaginal junction so that he can complete the surgery safely. Our techniques provide an aid for such difficult situations.

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  1. The American College of Obstetricians and Gynecologists (ACOG). Committee Opinion No 701: choosing the route of hysterectomy for benign disease. Obstet Gynecol 2017;129(6):e155–e159. DOI: 10.1097/AOG. 0000000000002112.
  2. Reich H, McGlynn F, Sekel L. Total laparoscopic hysterectomy. Gynaecol Endosc 1993;2: 59–63.
  3. Van den Haak L, Alleblas C, Nieboer TE, et al. Efficacy and safety of uterine manipulators in laparoscopic surgery: a review. Arch Gynecol Obstet 2015;292(5): 1003–1011. DOI: 10.1007/s00404-015-3727-9.
  4. Popa A, Copaescu C, Horhoianu V. Laparoscopic total hysterectomy still not routinely chosen: operative description and available instruments. J Med Life 2019;12(3): 301–307. DOI: 10.25122/jml-2019-0051.
  5. Macciò A, Madeddu C, Kotsonis P, et al. Feasibility and safety of total laparoscopic hysterectomy for huge uteri without the use of uterine manipulator: description of emblematic cases. Gynecol Surg 2018; 15(1): 6. DOI: 10.1186/s10397-018-1037-5.
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