Stepwise Colpotomy With Selective Vaginal Septum Trimming During Total Laparoscopic Hysterectomy for High-Reaching...

A high-reaching longitudinal vaginal septum presents specific technical challenges during total laparoscopic hysterectomy, particularly in achieving controlled colpotomy and tension-free vaginal cuff closure. In asymptomatic patients, the optimal timing and extent of septal resection remain undefined, and routine complete excision may represent overtreatment. We report a case of total laparoscopic hysterectomy performed using a stepwise colpotomy guided by independent vaginal landmarks in a patient with a complete uterine septum and complete longitudinal vaginal septum extending to the cervix. Colpotomy was completed with partial septal transection, and septal management was intentionally deferred until vaginal cuff closure. Selective trimming was limited to the septal segment mechanically interfering with suturing, enabling tension-free closure while preserving vaginal anatomy. This case suggests that stepwise colpotomy with deferred selective septal trimming may facilitate total laparoscopic hysterectomy in selected patients with a high-reaching longitudinal vaginal septum and offers an anatomically conservative alternative to routine complete septal excision.