Partial resection is often necessary. Once the rectum and ureters have been cleared, the main dangers are eliminated. The nodule remains in contact with the vagina and the posterior face of the uterus. A vaginal touch will allow the relationships between the nodule and the vagina to be better appreciated. All indurated zones must be removed, cutting wide in soft tissue so as to avoid leaving any pathological tissue.
Vaginal resection is therefore commonplace, and practically systematic for large nodules.
A glove filled with large compresses is placed in the vagina to maintain the pneumoperitoneum when the vagina is opened. The nodule is extracted via the vagina if resection is necessary, or by enlarging a trocar orifice if this is not the case. When vaginal resection has been performed, the vagina is sutured laparoscopically with individual figure of 8 sutures. Iterative haemostasis with bipolar forceps should be avoided, as it compromises scarring. Sutures should be preferred.