By colpotomy is meant making an opening into the peritoneal cavity through the vagina; the operation is known as anterior or posterior colpotomy, according to whether the opening is made through the anterior or posterior fornix.
Colpotomy has certain advantages over abdominal section. There is less interference with the peritoneum and intestines, and therefore less shock; if pus is present, there is less risk of infecting the general peritoneal cavity, and better drainage; there is no abdominal scar, and therefore no risk of hernia; lastly, there are certain pathological products which can be more easily reached by this route. The operation is difficult in a nullipara, where the vagina is narrow, and easier in a multipara, where the vagina is more capacious, and it is still easier if the cervix can be drawn down as far as the vaginal orifice.
A serious disadvantage is that, during the course of the operation, it may be found impossible to deal adequately with the conditions for which the operation is being performed; in the case of a tumour, for instance, its size, position, or the presence of adhesions may render it necessary to complete the operation by the abdominal route. Further, in more than one instance, the abdomen has had to be opened after the completion of the operation on account of bleeding, the source of which could not be dealt with by the vagina.
Therefore, before deciding upon the removal of a tumour by colpotomy, all the above points must be taken into consideration.
Indications. When the above conditions are fulfilled, colpotomy is suitable for:—
(i) The evacuation of collections of pus or blood in Douglas’s pouch.
(ii) The removal of fibro-myomata, ovarian tumours of small size, and early tubal pregnancies.
(iii) The drainage of collections of pus or the removal of the appendages in cases of acute inflammation where immediate operation is necessary.
(iv) Conservative operations upon the Fallopian tubes or ovaries.