What is Colpotomy?

A Tubal Ligation Procedure

Definition of Colpotomy:

A colpotomy is a type of incision that is made in the back wall of the vagina. During a tubal ligation, your doctor can use a colpotomy (also known as a 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. The colpotomy method of tubal ligation was once the preferred female sterilization technique.

But now, doctors usually use laparoscopy or laparotomy since these abdominal tubal ligation procedures do not have as many risks as a colpotomy.

Pronunciation: Colpotomy: col·pot·o·my (käl′päd·ə·mē)

What Happens During a Tubal Ligation Procedure that Uses a Colpotomy Incision?

A colpotomy is a type of incision that is used during a vaginal sterilization procedure (the other type is called culdoscopy). During a colpotomy tubal ligation, an incision is made into the posterior vaginal fornix (the medical word for the back of the vagina). This incision can be made horizontally or vertically. The surgeon then inserts a intrauterine sound through the incision and into the peritoneal cavity (the space within the abdomen that contains the intestines, the stomach and the liver). The intrauterine sound is an instrument designed to help probe and open passages within the body --  it helps the surgeon to correctly position the uterus and bring the fallopian tubes to view.

Some surgeons may use an endoscope (a small, telescope-like instrument with a light). The fallopian tubes are brought out through the incision and into the vagina. The surgeon then closes the tubes -- they can be tied, clipped, and/or sealed shut. The tubes are put back into place, and the 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 same day. It is considered to be a permanent method of contraception.

Benefits of Colpotomy:

A major advantage of having a colpotomy during your tubal ligation is that there are no incisions in your abdomen. A colpotomy tubal ligation can be a safer option for women who:

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

What to Expect After a Colpotomy Tubal Ligation:

Expect that recovery from a colpotomy will take a few days. Your doctor 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 you colpotomy, you will not have any visible scars.

Disadvantages of Colpotomy:

There are not as many surgeons in the United States who are trained to preform colpotomy as a tubal ligation procedure. Research is now showing that this method may be safer than originally thought.

But many surgeons 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. Colpotomy tubal ligations have also been linked to higher infection rates. Some surgeons will provide you with antibiotics to take after a colptomy to help prevent infection. 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.

Sources:

Ayhan A, Boynukalin K, Salman MC. "Tubal ligation via posterior colpotomy." International Journal of Gynecology & Obstetrics. 2006 Jun 30; 93(3):254-5. Full article accessed via private subscription.

Chang, WH et al. "Tubal ligation via colpotomy or laparoscopy: A retrospective comparative study." Archives of Gynecology and Obstetrics. 2011; 283(4):805-808. Full article accessed via private subscription.

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