Culdolaparoscopic oophorectomy with vaginal hysterectomy: An optional minimal-access surgical technique

Background and Purpose: Oophorectomy during vaginal hysterectomy may be difficult or impossible when the ovaries lie high in the pelvis or when adhesions are present. A new technique of culdolaparoscopic oophorectomy during vaginal hysterectomy is described. Patients and Methods: After the uterus is removed, a 12-mm cannula is introduced into the culde-sac, and a pneumoperitoneum is created. A 10-mm telescope is inserted through the vaginal port, and, under culdoscopic surveillance, two or three 3-mm abdominal ports are placed. The 10-mm telescope is removed, and a minilaparoscope is introduced through one of the abdominal cannulas. Oophorectomy is performed with a coagulator and scissors introduced via the vaginal port, and the ovaries are extracted through the vaginal cannula. Eight patients with pelvic adhesions found at the time of vaginal hysterectomy underwent culdolaparoscopic oophorectomy. Results: The procedure lasted between 28 minutes and 45 minutes, including adhesiolysis, removal of an enlarged ovary, and a liver biopsy. No complications occurred in any of the patients. Conclusion: Culdolaparoscopic oophorectomy is a simple minimal-access surgical technique for removing the ovaries when these are not easily accessible at vaginal hysterectomy.