Our objective: to disseminate and collect information in culdoscopy and culdoscopy related techniques.

Culdolaparoscopy

Background; At the present time  there is a trend to use smaller abdominal trocars in Laparoscopy. Microlaparoscopy uses  3 mm or smaller trocars.
however , in some cases  due to limited visual field, rapid insufflation, heavy irrigation, difficult extraction or the need to use larger operative instruments a greater sized port is required.
In Culdolaparoscopy, a vaginal trocar is placed inside the peritoneal cavity under laparoscopic surveillance  to facilitate the above mentioned functions.
The port  is to be use  mainly in assisting Laparoscopic surgery  with a vaginal visual  and extracting port ( Culdoscopy Assisted Laparoscopy Surgery)  There is a more versatile use that we call  Culdolaparoscopy. When the function of all ports abdominals or  vaginal can change from being a visual , operative or extracting aid depending on the nature of the procedure or the stage of the operation. This procedure was proved to be feasible in appendectomy, cholecystectomy, hysterectomy, myomectomy, oophorectomy and salpingoophorectomy.

Letter to the Editor of the Journal of the American Association of Gynecologists Laparoscopists published before Natural Orifice Transluminal Endoscopic Surgery.

Presented at the XVI FIGO World Congress of Gynecology and Obstetrics.
Washington, D.C. ,USA. September 2000. 

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References:
1. Culdolaparoscopy a preliminary report
Tsin D.A. J Soc. Laparoendosc Surg 2001;5:69-71

2. Operative Culdolaparoscopy: A novel approach combining operative culdoscopy
with minilaparoscopy, Tsin DA, Colombero LT, Mahmood D, Padouvas J, Manolas P. J Am Assoc Gynecol Laparoscopists. 2001;8:438-441

3. Development of flexible culdoscopy (letter). Tsin DA, J Am Assoc Gynecol
Laparoscopists 2000;7:440

4. Culdolaparoscopic Oophorectomy with Vaginal Hysterectomy: An Optional
Minimal-Access Surgical Technique. Tsin DA, Bumaschny E, Helman M, Colombero LT. J Laparoscopic & Advanced Surgical Techniques 2002;12:269-271

5. Vaginal extraction of the intact specimen following laparoscopic radical
Nephrectomy (letter). Tsin DA, J Urol 2002;188:1110

6. Culdolaparoscopic cholecystectomy during vaginal hysterectomy. Tsin DA,
Sequeira RJ, Giannikas G. J Soc Laparoendoscop Surg. 2003;7:171-172

7. Evolucion de la Culdoscopia : Un siglo de evolucion en Ventroscopia.
Cirugia Laparoscopica y Videoasistida en Ginecologia. Pag 394-398.
Editor: Dr. Pablo Rebon. Published by CiLap, Buenos Aires, Argentina. 2004

Correspondence:

My experience in Culdolaparoscopy
Dr. Eduardo Bumaschny

Culdolaparoscopy is a procedure that provides access to the abdominal cavity via the posterior vaginal fornix. The technique is simple and safe. In most cases, the procedure begins with a posterior colpotomy. A small incision is made between the 2 Allis clamps placed in the posterior fornix and into the cul-de-sac. The incision is then dilated with a 10 mm blunt rod to accommodate a cannula. The cannula is used for insufflation. To prevent leakage of the pneumoperitoneum, soaked vaginal packing is placed around the cannula serving as a tamponade. The pneumoperitoneum facilitates the exploration of the pelvic and abdominal cavities and allows for good visualization of the superior aspect of the liver. 

Using a 10 mm scope with a 30-degree angle placed transvaginally. The abdominal trocars are placed while under culdoscopic vision of the anterior wall of the cavity. The port size can range from 5 mm to 2 mm providing excellent cosmetic results.

A 5 mm or 3 mm laparoscope is then placed in one of the abdominal ports and the vaginal port is used as an operative port. For the extraction, the colpotomy incision can be enlarged to accommodate the removal of a larger specimen. Closing a colpotomy has less risk of an incisional hernia or evisceration than that of a laparotomy incision.

My personal experience with culdolaparoscopy includes a case of a liver biopsy of a lesion in segment 5 during a vaginal hysterectomy combined with a culdolaparoscopic oophorectomy. The biopsy was a relatively easy procedure. Under culdoscopic vision, a 5 mm biopsy forceps was placed in the right lower quadrant operative port. 

An important fact is that during the performance of a classic vaginal hysterectomy, the abdominal cavity is not explored, but with the aid of culdolaparoscopy, it is possible to explore the abdominal cavity and, as in this case, find and biopsy a liver lesion.

Eduardo Bumaschny MD, FACS
Professor of Surgery
University of Buenos Aires.
Argentina.

A Plea for Aesthetics in Laparoscopy

Minimally invasive laparoscopic surgery should include attention to the aesthetic results. Unfortunately, attention to aesthetics is the exception rather than the rule. The surgical approach must emphasize strategic trocar placement to maximize the use of Langer’s lines and natural skin curvatures. Microlaparoscopy and culdolaparoscopy can further enhance cosmesis in selected cases. Attention to aesthetics must be a priority when performing laparoscopy, because the patient is the one who has to live with the scars.

Oscar D. Almeida , Jr., MD
Mobile . Alabama. USA

Dear Dr. Tsin,

On 6-26-01 we at The New York Hospital Medical Center of Queens satisfactorily performed a vaginal hysterectomy and immediately a culdolaparoscopic cholecystectomy on a 39 years old female. I believe this is a feasible option in selected patients.

Rodrigo J. Sequeira M.D. F.A.C.S.
Flusing, New York. U.S.A.