Posterior Colpotomy for Laparoscopic Myomectomy Specimen Extraction

The purpose of this video is to demonstrate the posterior colpotomy approach for removal of a fibroid specimen during a laparoscopic myomectomy. The surgery took place in an academic hospital with a minimally invasive gynecologic surgeon. A 30-year-old G0 female with a fibroid planning a laparoscopic myomectomy. She had a history of a spontaneous abdominal wall infection requiring excision with general surgery which was complicated by delayed wound healing. She was consented for posterior colpotomy specimen extraction rather than extension of a port site given this history. Intervention: We describe our approach to creation of a posterior colpotomy to remove a fibroid during a laparoscopic myomectomy. After performing the myomectomy, we kept a uterine manipulator in place to antevert the uterus and placed a laparoscopic specimen retrieval bag in the posterior fornix of the vagina. Laparoscopic monopolar scissors were used to palpate the bag in the posterior cul de sac and make an incision overlying the bag between the uterosacral ligaments. The bag was advanced into the pelvis and the specimen was placed into the bag. We then laparoscopically sewed the colpotomy site. While not as commonly performed as it is often easier and faster to extend and close an abdominal incision, existing research suggests that posterior colpotomy extraction represents a safe, practical, and sometimes preferable approach. This video highlights one such implementation of this useful tool for surgeons to employ and discusses existing research on the safety and outcomes of this approach.