Abstract New surgical techniques and technology have sim-plified laparoscopic hysterectomy and have enhanced the safety of this procedure. However, the surgical colpotomy step has not been addressed. This study evaluates the surgical colpotomy step in laparoscopic hysterectomy with respect to difficulty and duration. Furthermore, it proposes an alternative route that may simplify this step in laparoscopic hysterectomy.
A structured interview, a prospective cohort study, and a prob-lem analysis were performed regarding experienced difficulty and duration of surgical colpotomy in laparoscopic hysterec-tomy. Sixteen experts in minimally invasive gynecologic sur-gery from 12 hospitals participated in the structured interview using a 5-point Likert scale. The colpotomy in LH received the highest scores for complexity (2.8±1.2), compared to AH
and VH. Colpotomy in LH was estimated as more difficult than in AH (2.8 vs 1.4, p< .001). In the cohort study, 107 patients undergoing LH were included. Sixteen percent of
the total procedure time was spent on colpotomy (SD 7.8 %). BMI was positively correlated with colpotomy time, even after correcting for longer operation time. No relation was found between colpotomy time and blood loss or uterine weight. The surgical colpotomy step in laparoscopic hysterectomy should be simplified as this study demonstrates that it is time consuming and is considered to bemore difficult than in other hysterectomy procedures. Avaginal approach to the colpotomy is proposed to achieve this simplification