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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.
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.
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.
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.
Operative laparoscopy was followed by colpotomy for the excision of an unsuspected, 7 x 7.5-cm, colonic leiomyosarcoma intact. That surgical approach was quick and had all the benefits of operative laparoscopy without potentially increasing the risk of tumor spread by cutting through malignant tissue.
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.
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.
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Total Hysterectomy has been until non performed by extracervical "enucleation" of the fascia of the uterine corpus with amputation of the vagina. The new method leaves the extrafascial highly vascularised vascular stem, the corresponding nerves and the topography of the ureter untouched. It is limited to an intrafascial cylindriform enucleation of the cervix. The diameter of the cervical cylinder can be determined beforehand by vaginal sonography. Punching-out is effected from a new instrument C.U.R.T. (= calibrated uterine resection tool) of 10-20 mm diameter. A cervicohaemostaser provides for safe transvaginal haemostasis in the residual cervix. The transvaginal sexual sensations of the patient are not impaired due to the fact that the cardinal ligaments are preserved as well as the nerve supply of the cervical fascia. Suspension of the cervical fascia at the supporting ligaments of the uterus can be performed in an ideal manner. Pelviscopic extirpation of the uterus is done in the classical way used in abdominal hysterectomy with ligature and suture. Morcellated cylinders of 2-3 cms in diameter, of the cervix and corpus uteri and even of myomas up to the size of a child's head, will suffice for relevant histological examination. The physical stress to which the patient is exposed is about the same as in routine surgical pelviscopy. The abdominal space remains practically unopened in pelviscopic transabdominal hysterectomy. Pelviscopic transabdominal hysterectomy with and without adnexae according to the CASH technique corresponds to surgery performed with a minimum of invasiveness. It is fully sufficient as regards cancer prophylaxis with respect to cervical or endometrial cancer.
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40 tubal sterilisations have been carried out in 5 years. The indications most often are for grand parity. The anatomical criteria for effective sterilisation by the vaginal route should be sought by gynaecological examination under general anaesthetic. The date for the operation, the technique and its difficulties have been described. The operation lasted on an average 30 minutes. The average stay in hospital was 8.2 days. Only one local complication using this techinque was noted. On one occasion the authors had to abandon the vaginal route to reach the tubes. This simple procedure without any aesthetic inconvenience seems to them to be the ideal route for tubal sterilisation.
An analysis was made of 1757 female sterilization procedures performed over a 5 1/2-year period. The majority of these were accomplished by one of 8 technics: puerperal abdominal tubal ligation (TL), cesarean section plus TL, hysterotomy plus TL, interval abdominal TL, colpotomy TL, laparoscopic TL, vaginal hysterectomy, and abdominal hysterectomy. The various technics have been compared with respect to 55 variables. The procedures having the shortest hospital stay, lowest morbidity, lowest blood loss, and shortest operating time were interval laparoscopic TL, colpotomy TO, and puerperal abdominal TL. The more major procedures were attended by significantly more morbidity and longer hospitalization and should be used only when specific indications justify the increased cost and risk.
Both posterior colpotomy with associated fimbriectomy and laparoscopy offer rapid and effective methods for carrying out interim and post-abortion tubal sterilization. They can effectively be performed on an out-patient basis. Posterior colpotomy has the added advantage that it can be conveniently performed under a combination of intravenous neuroleptanalgesia and local vaginal anesthesia. This series exemplifies the manner in which the burden upon hospital facilities and medical and paramedical personnel can be minimized. In addition, utilization of the "home-care program" has improved patient acceptance and convenience.
Records of twenty-six patients who presented at the University College Hospital, Ibadan with 'lost' IUDs between 1 July 1980 and 30 April 1982 were analysed. During the 22-month study period there were 3476 IUD insertions. Routine evaluation showed that eighteen IUDs (69.2%) were intrauterine whilst eight IUDs (30.8%) were extrauterine. Seventeen (65.4%) intrauterine devices were recovered by routine D and C. Of the eight extrauterine devices, six (23.1%) were removed by laparoscopy, one (3.8%) was removed by laparotomy and one (3.8%) was removed by colpotomy. It is concluded that it is preferable for all extrauterine devices to be removed in order to discourage psychosomatic symptomatology commonly associated with forgotten devices.
In recent years, the increased demand for sterilization by women who have achieved their desired family size has emphasized the need to improve both existing methods of tubal occlusion and the means of access to the Fallopian tubes. Utilization of diagnostic instruments such as the laparoscope and culdoscope to perform sterilization minimizes the trauma associated with standard laparotomy and colpotomy and promises to reduce morbidity occurring as a result of sterilization. In order to evaluate and compare the improved techniques of laparoscopy and culdoscopy for elective interval sterilization, 722 women were studied between January and August of 1973 at the Siriraj Hospital in Bangkok. For 279 patients (Group I), sterilization was performed by culdoscopic tubal ligation using a modified Pomeroy technique; for 443 patients (Group II), the procedure used was laparoscopic tubal cauterization and cutting. All procedures were performed using local anesthesia on an outpatient basis. Complication rates and required surgical time were similar for both procedures and compared favorably with rates reported by other investigators. Because of a low incidence of complications and the elimination of the need for general anesthesia and hospitalization, both endoscopic procedures appear to be of particular value in developing countries where hospital facilities and physician time are in short supply.
From the array of sterilization procedures that are safe, simple and effective, the service provider must select procedures that fit his or her logistical criteria, which include the cost and maintenance of equipment, availability of supplies, and training of the requisite personnel. In this paper, these criteria are discussed for each of the various sterilization procedures. Information about female sterilization equipment for conventional postpartum laparotomy, minilaparotomy, colpotomy, laparoscopy, and culdoscopy is presented, together with facts about the related tubal occlusion techniques. The standard ligation techniques for male sterilization are compared with the newer electrocoagulation and thermocoagulation methods. A variety of methods for both female and male sterilization that are in the research stage are also mentioned. It is concluded that, from a programmatic point of view, vasectomy and postpartum ligation via laparotomy are the optimal sterilization procedures. For women who have not recently been pregnant, minilaparotomy with a standard tubal ligation technique is recommended, except in large teaching hospitals where laparoscopy can be performed efficiently.