Posterior cervicotomy

The management of a leiomyomatous polyp is easy if it is hanging down in the vagina, its widest transverse diameter having passed through the cervical rim. The pedicle is clamped, cut and ligated. If it cannot be reached, it is broken by twisting the polyp around its long axis. If the polyp is in the uterocervical canal and the external os is closed, the polyp is removed using an operative hysteroscope, either with a wire loop or laser. But if the cervix is open, hysteroscopy cannot be done, as the uterine cavity cannot be distended, the fluid leaking out through the open cervix. In such cases, if the size of the polyp is up to 10 cm in diameter, posterior cerviciotmy is useful.

1. The patient is placed in lithotomy position.
2. The posterior lip of the cervix is held with two Allis’ forceps on either side of the midline. The posterior cervical wall is cut with a scalpel in midline until the pedicle of the polyp is reached.
3. The polyp is held with a tenaculum. The pedicle is clamped, cut, and ligated with No. 1 polyglactin 910 suture.
4. The posterior cervical incision is sutured with interrupted sutures of No. 1 polyglactin 910 suture.