Using a vaginal tube to separate the uterus from the vagina during laparoscopic hysterectomy

Hysterectomy performed totally by laparoscopy has few advocates because separating the cervix from the vagina is difficult. This technical difficulty can be overcome by placing a wide-bore plastic tube in the vagina to expose the cervico-vaginal junction and stretch the vaginal fornices. The stretched vagina falls away from the cervix as diathermy cuts over the tube rim. The tube guides the incision, and the plastic protects any adjacent structures. The most convenient external diameter is between 4-5 cm. Made from smooth, electrically-inert plastic, the tube's opposite distal end has a valve that maintains the pneumoperitoneum. We have used it in 73 cases, and the only associated complication has been one vault pelvic hematoma.