This is the video of vaginal salpingectomy via posterior transverse colpotomy as an option for female sterilization, presented by Woojin Chung at Mount Sinai Medical Center in New York. We have nothing to disclose. As a background information, female sterilization can be performed abdominally, laparoscopically, and vaginally. Since the laparoscopic route has become popular, female sterilization by colpotomy has been underutilized. In the past, female sterilization by colpotomy was mainly carried out via tubal occlusion or tubal ligation. The average operating time ranges between 12 to 30 minutes. Complications occur very rarely. Known complications include pelvic infection, bleeding, and dyspareunia. It is believed that removing fallopian tubes may prevent developing ovarian cancer. Complete salpingectomy is preferred. Vaginal salpingectomy offers most economic form of female sterilization with fewer surgical instruments needed, less over time, faster recovery, minimal morbidity, and re-hospitalization. The objectives of this video are to revisit the value of vaginal salpingectomy as a female sterilization method and to present a surgical method of vaginal salpingectomy via posterior transverse colpotomy. A 41-year-old para-tube with stressed urinary incontinence and desire for permanent sterilization came to clinic. No significant medical or surgical histories were noted except for history of abdominoplasty. Pelvic exam reveals a small mobile uterus and positive cough stress test. Urine analysis was negative. Risks and benefits and alternatives were discussed with the patient. Surgical planning was made for retroperic transvaginal sling, cystoscopy, and vaginal salpingectomy through colpotomy. Propylactic antibiotic was given, and patient was positioned in a dorsal lithotomy with a mild trendellum burn positioning. The patient was prepped and draped in a usual cerv fashion. After the cervix was identified with a proper visualization, the vaginal epithelium over the posterior cul-de-sac was grasped using Alice clamps. Another pair of Alice clamps were used to grasp the vaginal epithelium 2 centimeter distal from the first one. At this time, rectal exam was performed to confirm that rectum is at least 2 centimeters away from the distal Alice clamps. While tenting up the vaginal tissue between two Alice clamps, a transverse incision was made using curved male scissors. While keeping tension on the vaginal epithelium, the peritoneal layer was grasped using Alice clamps. The peritoneum was entered using male scissors and extended digitally. The midline of anterior and posterior peritoneal layers were tagged along with the vaginal epithelium using figure of eight stitches. The pelvic organs were pipetted through the copatomy, and then a weighted posterior speculum was inserted along the posterior vaginal wall with its terminal end in the pouch of Douglas. A lateral retractor was utilized to push away the bowels from the surgical field. After identifying the left femuria, the fallopian tube was gently grasped using Babcock clamps. An ender loop was placed over the Babcock clamp and carefully moved down toward the most proximal portion of the fallopian tube possible to reach, and then the loop was cinched down. The fallopian tube was resected 0.5 centimeter distal from the knotted loop and sent to pathology. The same steps were repeated for the contralateral side. Complete stop injectomy is preferred over the femur reenactomy. However, if not feasible, removing as much of fallopian tubes as possible, excluding the interstitial portion, still may have some value. To close the copatomy created, the most lateral edges were grasped using Ellis clamps. Ensuring to incorporate the peritoneal layer, the vaginal epithelium was re-approximated transversely using an absorbable sutures with a multiple figure of eight stitches. Final presentation after vaginal stop injectomy via posterior transverse copatomy is shown here. TBT and cystoscopy were followed for the treatment of stressed urinary incontinence. Patients tolerate the procedure well, passed voiding trial, and went home on the same day. A two-week visit post-op, the patient was recovering well and expressed satisfaction. In conclusion, female sterilization can be performed abdominally, laparoscopically, and vaginally. Vaginal route for female sterilization should be re-explored. It is especially useful when performing other vaginal procedures, such as TBT sling or posterior repair, since repositioning of the patient is not needed. Complete stop injectomy is preferred to tubal occlusion or ligation, since removing the fallopian tubes may prevent developing ovarian cancer. Vaginal stop injectomy offers most economic form of female sterilization with fewer surgical instruments needed, less over time, faster recovery, minimal mobility, and re-hospitalization rate. Vaginal stop injectomy is not ideal for women whose uterus is larger than 9 to 10 centimeters and who may have pelvic adhesions. Thorough preoperative evaluation is important to allow these contraindications. These are our references. Thank you. For comments and questions, email at www.oojin.gmail.com.

vaginal salpingectomy

female sterilization

posterior transverse colpotomy

laparoscopic methods

surgical procedure