Posterior cervicovaginotomy

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. If it is bigger, an abdominal posterior cervicovaginotomy is useful.

1. The patient is placed in supine position.
2. An exploratory laparotomy is done.
3. The posterior vagina stretched over the leiomyoma is cut in the midline with a scalpel.
4. The pedicle of the polyp is identified. It is divided with scissors.
5. The leiomyomatou polyp is removed through the posterior vaginal incision by morcellation.
6. Though I have described a posterior vaginal incision often the adjacent part of the cervix gets cut, as it is effaced out and boundary between the cervix and vagina is lost.
7. The vaginal and cervical incision is closed with interrupted sutures of No. 1 polyglactin 910 sutures.

An advantage of this operation over Ruterford Morrison’s operation is that the uterine cavity is not opned and hence there is no risk of rupture of the uterus in a future pregnancy. Another advantage is that the incision is small and low down in the pouch of Douglas, reducing the risk development of adhesions with bowel and omentum.