ABSTRACT
Stage IIA endometriotic cancers can be treated by extrafascial simple complete hysterectomy with colpectomy. In such cases, colpectomy is taken up after the initial stages of a Schanta operation: fashioning the cuff following the vaginal incision, opening the Douglas’ pouch and vesicouterine space. One must then remove the adjacent tissue from the four vaginal fornices. The tissue in the front and the back can be removed without haemostasis, while remaining in contact with the vagina. Laterally, progressive haemostasis (electric or using forceps) are necessary, while remaining in contact with the vagina’s far wall. A simple complete hysterectomy can now be commenced. This procedure will be extrafascial, since the cardinal ligaments will be treated a few millimetres from their insertion. There will be no risk to the ureter if the bladder pillar is pushed out of the way by a retractor placed within the vesicouterine septum, as required for simple complete hysterectomy (figure 12.1).
