|December 2006 · Vol. 18, No. 12
COMMENT & CONTROVERSY
Tip for difficult colpotomy at vaginal hysterectomy
“Vaginal hysterectomy: 6 challenges, an arsenal of solutions,” by Barbara S. Levy, MD
Dr. Levy’s enjoyable article inspired me to offer this solution to another common challenge. Vaginal hysterectomy traditionally begins with an anterior colpotomy followed by a posterior one. When the latter is difficult, I instill 200 to 300 mL of sterile normal saline through the opening of the anterior colpotomy, which causes the posterior cul-de-sac to bulge. This swelling of Douglas’ cul-de-sac facilitates entry into the cavity, as the incision initiates the escape of instilled saline.