To the editor:
I read with interest Dr. Eric J. Bieber’s March 2004 article (“Laparoscopic tissue extraction: Pros and cons of 4 techniques”) and agree that most surgeons extract tissue through abdominal ports, which is the simplest technique.
However, I sometimes utilize a vaginal port to aid in laparoscopy as well as minilaparoscopy; I refer to this procedure as “culdolaparoscopy.” This multifunctional vaginal port can be used for insufflation, visualization, operation, and extraction of the specimen.1,2 The technique can be performed when there is easy access to the posterior vaginal fornix with no obliteration of the posterior cul-de-sac.
As for the difficulty of using a posterior colpotomy to remove more than 1 specimen, different techniques that address those disadvantages have been described.3,4 Dr. Bieber also expressed concern about subsequent adhesion formation, but colpotomy yields good cosmetic results and decreases the risk of incisional hernias, and a literature review and multicenter study suggests it is safe.4
In my experience, there are fewer candidates for colpotomy or culdolaparoscopy than for the use of abdominal ports. However, I recommend a vaginal approach when it is possible and appropriate, as it allows the removal of large specimens while using abdominal ports no more than 3 mm or 5 mm in diameter.
DANIEL A. TSIN, MD
LONG ISLAND CITY, NY
References
- Tsin DA. Culdolaparoscopy: a preliminary report. JSLS. 2001;5:69-71.
- Tsin DA, Colombero LT, Mahmood D, Padouvas J, Manolas P. Operative culdolaparoscopy: a new approach combining operative culdoscopy and minilaparoscopy. J Am Assoc Gynecol Laparosc. 2001;8:438-441.
- Tsin DA, Colombero LT. Laparoscopic leash: a simple technique to prevent specimen loss during operative laparoscopy. Obstet Gynecol. 1999;94:628-629.
- Ghezzi F, Raio L, Mueller MD, Gyr T, Buttarelli M, Franchi M. Vaginal extraction of pelvic masses following operative laparoscopy. Surg Endosc. 2002;16:1691-1696.