Culdoscopy is an

endoscopic An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

procedure performed to examine the

rectouterine pouch The rectouterine pouch (recto-uterine pouch), pouch of Douglas, or rectovaginal pouch is the extension of the peritoneum between the rectum and the posterior wall of the uterus in the human female. Its anterior boundary is formed by the posterior f ...

and pelvic viscera by the introduction of a

culdoscope Culdoscope is an instrument, a kind of endoscope, used to visualize female pelvic organs, introduced through the vagina into the cul-de-sac (which is also called the rectouterine pouch or the pouch of Douglas). The procedure of inserting the cul ...

through the posterior

vaginal In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hyme ...

wall. The word culdoscopy (and

) is derived from the term

cul-de-sac A dead end, also known as a cul-de-sac (, from French for 'bag-bottom'), no through road or no exit road, is a street with only one inlet or outlet. The term "dead end" is understood in all varieties of English, but the official terminology ...

, which means literally in

French French (french: français(e), link=no) may refer to: * Something of, from, or related to France ** French language, which originated in France, and its various dialects and accents ** French people, a nation and ethnic group identified with Franc ...

"bottom of a sac", and refers to the

(or called the

pouch of Douglas The rectouterine pouch (recto-uterine pouch), pouch of Douglas, or rectovaginal pouch is the extension of the peritoneum between the rectum and the posterior wall of the uterus in the human female. Its anterior boundary is formed by the posterior f ...

). The culdoscope is a non-flexible endoscope, basically a modified laparoscope. A

trocar A trocar (or trochar) is a medical or veterinary device that is made up of an awl (which may be a metal or plastic sharpened or non-bladed tip), a cannula (essentially a hollow tube), and a seal. Trocars are placed through the abdomen during lap ...

is first inserted through the vagina into the posterior cul-de-sac, the space behind the

cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...

, allowing then the entry of the culdoscope. Due to the position of the patient intestines fall away from the pelvic organs which can then be inspected. Conditions diagnosable by culdoscopy include tubal adhesions (causing sterility),

ectopic pregnancy Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. ...

, and

salpingitis Salpingitis is an infection causing inflammation in the Fallopian tubes (also called ''salpinges''). It is often included in the umbrella term of pelvic inflammatory disease (PID), along with endometritis, oophoritis, myometritis, parametritis, ...

. Culdoscopy allows the performance of minor procedures such as tubal sterilization. Culdoscopy is performed with the patient in a

knee chest position In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the ...

under local or general anesthesia. There is no insufflation of the abdomen as necessary in laparoscopy. There is no abdominal incision, the entry point in the vagina is closed with a suture. The procedure was inaugurated by Albert Decker in 1939 and became popular after his reported experience in 1944. Decker had his culdoscope made by American Cystoscope Makers (ACM). He published a textbook about culdoscopy in 1952. The use of culdoscopy faded in the 1970s as the laparoscopic approach was recognized to be superior due to technological advancements.

References

* Tsin DA, Colombero LT, Mahmood D, Padouvas J, Manolas P. Operative culdolaparoscopy: a new approach combining operative culdoscopy and minilaparoscopy. J Am Assoc Gynecol Laparosc. 2001 Aug;8(3):438-41. {{PMID, 11509789 Gynecological surgery Medical treatments Endoscopy