Female urogenital surgery
How to – Colpotomy
Indications
Colpotomy is useful for access to the peritoneal cavity for ovariectomy, mummy removal and cervicopexy. It has been used to access the bladder for tumor removal, as well.
Relevant anatomy
The peritoneal cavity is entered at 2:00 or 10:00 from the vaginal fornix. This avoids the rectum (12:00), bladder (6:00) and iliac arteries (3:00 and 9:00). The upper incisions also decrease the risk of evisceration.
Preoperative management
Food restrictions: Hold patients off feed for 24 hours to minimize abdominal fill.
NSAIDs/analgesics: Perioperative NSAIDs are recommended.
Antibiotics: Perioperative antibiotics are recommended as it is a contaminated procedure.
Local blocks: Epidural and splash block
Position/preparation: The patient is restrained standing. Sedation is recommended.
Surgery Supplies:
- Colpotomy spear – scissors, ovariectomy device, ring blade or scalpel
Surgical procedure
Create a pneumovagina to tense the vaginal wall.
After the vaginal is cleansed, the surgeon punctures the wall of the vagina and the peritoneum. This should be done quickly and relatively forcefully or the peritoneum will be pushed away rather than punctured. As the peritoneum is hard to block, this portion of the procedure can be painful.
The incision is made at 2:00 or 10:00, above the cervix.
The incision is left open in most cases. Closure would require laparoscopic type instruments.
Postoperative care
- Stall or pen rest for 3 days
- Horses may be restrained in a standing position to minimize the risk of evisceration.
Complications
- Peritonitis
- Intestinal evisceration- considered less likely in cows since they get up in the hindend first and this creates a tilt
- Trauma to internal organs
- Inability to puncture the peritoneum
