Colpotomy During a Tubal Ligation

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A colpotomy is a type of incision that is made in the wall of the vagina. It's a surgical technique that may be used for a number of procedures, including hysterectomy, tubal ligation, complications of endometriosis, and cervical cancer treatment.

With tubal ligation, your healthcare provider can use a colpotomy (previously known as vaginotomy) as one of the ways to reach your fallopian tubes. A tubal ligation that uses a colpotomy incision is considered to be minimally invasive surgery, and may be used in specific circumstances.

This article discusses the colpotomy procedure and its uses during tubal ligation. It will help you to know what to expect when considering the benefits of this surgery as well as its drawbacks.

Colpotomy preparation
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Overview

The colpotomy method of tubal ligation was once the preferred female sterilization technique. But now, healthcare providers usually use laparoscopy or laparotomy since these abdominal tubal ligation procedures do not have as many risks as a colpotomy.

The Procedure

A colpotomy is a type of incision that can be used during a vaginal sterilization procedure; the other type of procedure is called a culdoscopy.

After an incision is made into the vaginal wall, the surgeon will then insert an endoscope (a small, telescope-like medical instrument with a light) or an instrument called an intrauterine sound into the peritoneal cavity. This is the space within the abdomen that contains the intestines, the stomach, and the liver.

The instruments are used to help your surgeon to correctly position the uterus and bring the fallopian tubes into view.

Your surgeon will then take your fallopian tubes out through the incision and into the vagina. Your fallopian tubes are then closed/ligated—they can be tied, clipped, and/or sealed shut. Finally, your healthcare provider will put the fallopian tubes back into place, and your incision is stitched shut.

A tubal ligation that includes a colpotomy incision takes about 15 to 30 minutes. Most women are able to go home the very same day. This type of procedure is considered to be a permanent method of contraception.

Anterior vs. Posterior Colpotomy

The terms anterior (front) and posterior (back) refer to the part of the vaginal wall where an incision is made during a colpotomy.

What to Expect Post-Procedure

You can expect that your recovery from a colpotomy will take a few days. Your healthcare provider will probably advise you to wait to have sexual intercourse until your incision has completely healed—this usually takes several weeks.

Once you have healed from your colpotomy, you will not have any visible scars.

Colpotomy Indications: Pros

A major advantage of having a colpotomy during your tubal ligation is that there are no incisions in your abdomen. This type of tubal ligation can also offer additional benefits. 

Reasons for colpotomy in tubal ligation and other procedures include the likelihood that it is a safer option for women who:

  • Are obese
  • Have a retroverted uterus (a uterus that tilts back instead of the front)
  • Have a history of abdominal wall/hernia repairs

Colpotomy Drawbacks: Cons

One concern is that many surgeons in the United States are trained to perform a tubal ligation procedure, but fewer are trained in colpotomy as a tubal ligation method.

Surgeons may prefer to do abdominal tubal ligations because the complication rates associated with colpotomy tubal ligations appear to be twice as high, and the effectiveness rates may be slightly lower. However, some studies suggest that is not always the case.

For example, colpotomy is believed to be linked to higher infection rates. Yet research involving 45 people who had colpotomy procedures found that just one had a urinary tract infection after the surgery. In some cases, antibiotics after colpotomy also may help to prevent infection.

Another complication involves painful sex after the procedure is done. However, a study of 40 women who had colpotomy procedures to treat a urethral (urine tube) disorder, one that caused painful sex itself, found them to be pain-free during sexual encounters after the surgery.

A colpotomy may also be more difficult to perform because it requires a woman to be in a lithotomy position (your legs are in stirrups) while under local anesthesia.

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