**3.4 Extraction (uterus retrieval)**

In most cases with big uteri, the time-consuming retrieval exceeds the time for uterus disconnection. In cases of a uterus weighing under 280gr vaginal retrieval is not a problem.

For the big uteri we can use other alternatives:


**Figure 19.** *Colpotomy starts from the lateral side of the vaginal cuff.*


Transvaginal morcellation is the leading method for uterus extraction. For the surgeon trained in vaginal surgery extraction of a uterus weighing 500–1000 gr is not a problem. To extract the uterus transvaginally, we use some techniques:


After colpotomy, the entire uterus remains free into the pelvis if the manipulator is extracted. The vaginal assistant grasps the cervix with a tenaculum pulling it into the vaginal canal.

Usually, we start transvaginal morcellation bilvalving of the uterus beginning from the external cervical orifice. This maneuver allows access to the lateral sides of the uterine body allowing to start the intramiometrial corring. The uterine body tissue is cut circularly with a knife or scissors forming a cylinder of tissue to reduce the volume of the uterus. If necessary, tissue fragments can be cut for uterine reduction. Finally, the whole uterus will be extracted vaginally.
