Laparoscopic Myomectomy and Salpingo-Oophorectomy with Palmer's Point and Extraction by Colpotomy
 
Introduction
Laparoscopic myomectomy and salpingo-oophorectomy are minimally invasive surgical procedures used to treat uterine fibroids and remove diseased ovaries and fallopian tubes, respectively. Advances in laparoscopic techniques have enhanced patient outcomes by reducing recovery time, minimizing surgical trauma, and improving cosmetic results. One such advancement is the use of Palmer’s Point for entry, along with colpotomy for specimen extraction, which improves surgical safety and efficiency.
 
Understanding the Procedures
 
Laparoscopic Myomectomy
Laparoscopic myomectomy is the removal of uterine fibroids (leiomyomas) while preserving the uterus. It is an ideal option for women desiring fertility preservation or symptom relief from heavy menstrual bleeding, pelvic pressure, or pain.
 
Salpingo-Oophorectomy
This procedure involves the removal of one or both ovaries and fallopian tubes. It is performed in cases of ovarian cysts, endometriosis, chronic pelvic pain, or risk-reducing surgery for ovarian cancer in high-risk patients.
 
Role of Palmer’s Point for Entry
Palmer’s Point, located in the left upper quadrant of the abdomen (approximately 3 cm below the left costal margin and 3 cm lateral to the midclavicular line), serves as an alternative entry site for laparoscopic access, particularly in cases of previous abdominal surgeries or suspected adhesions. The benefits of using Palmer’s Point include:
 
- Reduced risk of injury to intra-abdominal adhesions
- Safer access in patients with obesity
- Lower likelihood of vascular or bowel injuries compared to traditional umbilical entry
 
Extraction by Colpotomy
Colpotomy, a surgical incision made in the vaginal wall, is a preferred technique for specimen retrieval after laparoscopic gynecologic surgeries. The key advantages include:
 
- Avoidance of abdominal wall enlargement or mini-laparotomy
- Reduced postoperative pain
- Faster recovery and improved cosmesis
 
In laparoscopic myomectomy and salpingo-oophorectomy, colpotomy is performed through the posterior vaginal fornix, allowing the fibroids or adnexal structures to be safely removed without excessive tissue fragmentation.
 
Surgical Steps
1. Patient Preparation
- Preoperative evaluation with imaging and blood tests
- Bowel preparation in selected cases
- Antibiotic prophylaxis and thromboprophylaxis considerations
 
2. Trocar Placement Using Palmer’s Point
- The first trocar is inserted at Palmer’s Point using a Veress needle or direct trocar entry technique
- Additional ports are placed strategically for optimal visualization and instrument maneuverability
 
3. Laparoscopic Myomectomy and Salpingo-Oophorectomy
- Identification and excision of fibroids with meticulous uterine suturing
- Dissection and removal of affected ovaries and fallopian tubes, if indicated
 
4. Specimen Retrieval via Colpotomy
- A posterior colpotomy is performed to extract the specimen
- Use of an endoscopic bag may be employed to facilitate safe removal and reduce tissue dispersion
 
5. Closure and Postoperative Care
- Vaginal incision closure with absorbable sutures
- Careful inspection of hemostasis and thorough irrigation
- Postoperative pain management and early mobilization
 
Advantages and Considerations
The combination of Palmer’s Point entry and colpotomy extraction in laparoscopic myomectomy and salpingo-oophorectomy presents several advantages, including:
✅ Reduced risk of bowel and vascular injuries
✅ Less postoperative pain compared to morcellation-based retrieval
✅ Improved cosmetic outcomes with fewer visible scars
 
However, surgeons must be well-versed in patient selection and technique to minimize complications, such as vaginal cuff infections or pelvic adhesions.
 
Conclusion
Laparoscopic myomectomy and salpingo-oophorectomy using Palmer’s Point for entry and colpotomy for specimen extraction are effective techniques that enhance surgical safety and patient recovery. These innovations underscore the evolution of minimally invasive gynecologic surgery, offering women better outcomes with reduced surgical morbidity.


For more information:

World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi
INDIA : +919811416838

World Laparoscopy Training Institute
Bld.No: 27, DHCC, Dubai
UAE : +971525857874

World Laparoscopy Training Institute
8320 Inv Dr, Tallahassee, Florida
USA : +1 321 250 7653