Reinventing the culdoscope

The purpose of this study was to reassess culdoscopic visualization of the female pelvis using a small flexible fiberoptic choledochoscope introduced via a disposable trochar system. A disposable 5-mm retractable laparoscopic trochar was used to gain access to the peritoneal cavity via the posterior fornix of the vagina. A 4.9-mm flexible choledochoscope then was introduced through this trochar to visualize the pelvic organs. The initial procedures were performed with the patient under general anesthesia using direct laparoscopic visualization of the cul-de-sac. Subsequent procedures were performed on women who were awake, using local anesthesia and sedation with the patients in a knee-chest position. In this study, 18 women taken to the operating room for a planned transvaginal hysterectomy or laparoscopically assisted vaginal hysterectomy underwent flexible culdoscopy. Three procedures were performed with the patients under general anesthesia using direct laparoscopic visualization, and 15 procedures were performed in a blind fashion with the patient awake in a knee-chest position. The average Quetelet Index was 31.2 (range, 22.8-43.1). Of the 18 procedures, 16 were successful in adequately visualizing the pelvic organs. There were no significant complications from the procedures, and no injury to adjacent organs. Culdoscopy with a small flexible scope can be performed safely in awake patients, providing adequate visualization of the female pelvis.