Simplified Colpotomy for Total Laparoscopic Hysterectomy: The Vulsellum Technique

Background: Laparoscopic hysterectomy has a clear advantage over laparotomy due to early recovery, lesser blood loss and reduced risk of abdominal infections.The minimally invasive route is becoming the norm for hysterectomies and more gynecologists are now opting for this method than ever before.A crucial step in total laparoscopic hysterectomy (TLH) is that of colpotomy which requires adequate uterine traction and exposure.Numerous uterine manipulation techniques are now available, which can be expensive and add to the cost of the surgery.Aim: To describe a resourceful and efficient technique by using the vulsellum in aiding colpotomy during laparoscopic hysterectomy.Materials and methods: Retrospective analysis of 1,000 cases of laparoscopic hysterectomy performed for various benign gynecological indications wherein each surgery, the vulsellum was utilized to demarcate the site for colpotomy after optimum dissection of bladder from the cervix and vagina.The utility of this modification and its advantages are discussed.Results: The most common indications for hysterectomy were uterine fibroids (38%) followed by adenomyosis (30%).Post-operative surgical complications were attributable to the distorted pelvic anatomy due to adhesions, and none could be linked to the modified technique. Conclusion:This study successfully demonstrates the uses and benefits of a simple yet resourceful modification of technique in aiding colpotomy during laparoscopic hysterectomy.Clinical significance: Quick, easy and reproducible approach to demarcate the site for colpotomy in laparoscopic hysterectomy.Especially beneficial for beginners.It is an inexpensive approach utilizing readily available gynecological instruments.