Culdesac is the anatomical term given to the dead end of peritoneal
pouch lining the pelvic cavity. Utilization of seemingly inactive
anatomical corner may have unsurpassed potential benefits during
Laparoscopic Uterine Surgery. Before the advent of laparoscopy,
Colpotomy or colpoceliotomy was performed for diagnostic and therapeutic
purposes. The route of vagina was used to access into the abdominal
cavity. Culdotomy is, however, performed from the opposite direction by
the abdominal route to have an access into the vagina. Laparoscopy
simplifies and facilitates the Culdotomy procedure., The “new Colpotomy”
is Laparoscopic Culdotomy (LC) In place of performing “laparoscopically
assisted” procedures by enlarging the abdominal trocar site incision,
Laparoscopic CULDOTOMY is the preferred method for specimen removal.,
Traction by teneculum and Manual morcellation of the specimen are known
removal techniques through culdotomy. “Extended Culdotomy “ is a new
term to define incisions of culdesac over 4 cm. For multiple specimens,
techniques of Fishline and colpo-endobag are preferred over introducing
teneculum or claw forceps vaginally. Needle threading through multiple
specimens with suture is called Fisline technique. Fishlining
facilitates and secures the multiple specimens without being lost
between intestinal loops. More than one coldo-endobag may be necessary
for multiple specimens. In seleced cases single very large specimen ,
Culdo-morcelator may be preferred over using culdo-endobag prevent
consequent extended culdotomy. Advantages over umbilical site is as
follows; circular blade of the morcellator faces the abdominal wall as
opposed to big vessels and bowel, and umbilical insicion and the other
ancillary ports are kept minimal, 5 mm or less. Temporary obliteration
of uterine arteries by using tourniquet is a new technique for
minimizing blood loss during myomectomy and supracervical hysterectomy.
Ends of the turniquet are pulled out of the Culdotomy without being
tied. By using Uterine Artery Temperorary Obliteration (UATO) permanent
oblitaration of uterine arteries may be delaed until th corpus uteri is
detached from the cevix during Supracervical Hysterectomy for large
uterius. L With introduction of above defined new techniques, Culdotomy
will help Laparoscopic Surgery to win over and replace open abdominal
surgery even in seemingly impossible large uterine sizes.
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