These definitions are not necessarily mutually exclusive. Laparoscopic techniques have been used to assist ventral laparotomy approaches and, especially in the case of enlarged ovaries, laparoscopic approaches become a flank laparotomy at the point ofremoval of the organ from the abdomen. Colpotomy is an entry to the peritoneal cavity per vaginam, via incisions through the vestibular wall either side of the cervix. It is effectively performed 'blind', with ovaries handled through the incision and removed from their pedicles by means of an ecrasseur. It has the advantages of being performed without general anaesthesia (epidural analgesia is preferred), of providing reasonably easy access to the ovaries and of being relatively undemanding of specialist equipment and expertise. It has the disadvantages of a lack of full control over asepsis or haemostasis, and leaving open wounds into the peritoneum that are left to heal by second intention, with risk of peritonitis or herniation. It is also unsuitable for enlarged ovaries. The procedure is rarely practised these days, but there remain advocates of its use on pragmatic grounds.
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