Colpotomy has certain _advantages_ over abdominal section. There is less interference with the peritoneum and intestines, and therefore less shock; if pus is present, there is less risk of infecting the general peritoneal cavity, and better drainage; there is no abdominal scar, and therefore no risk of hernia; lastly, there are certain pathological products which can be more easily reached by this route. The operation is difficult in a nullipara, where the vagina is narrow, and easier in a multipara, where the vagina is more capacious, and it is still easier if the cervix can be drawn down as far as the vaginal orifice. A serious _disadvantage_ is that, during the course of the operation, it may be found impossible to deal adequately with the conditions for which the operation is being performed; in the case of a tumour, for instance, its size, position, or the presence of adhesions may render it necessary to complete the operation by the abdominal route. Further, in more than one instance, the abdomen has had to be opened after the completion of the operation on account of bleeding, the source of which could not be dealt with by the vagina. Therefore, before deciding upon the removal of a tumour by colpotomy, all the above points must be taken into consideration. =Indications.= When the above conditions are fulfilled, colpotomy is suitable for:-- (i) The evacuation of collections of pus or blood in Douglas’s pouch. (ii) The removal of fibro-myomata, ovarian tumours of small size, and early tubal pregnancies. (iii) The drainage of collections of pus or the removal of the appendages in cases of acute inflammation where immediate operation is necessary. (iv) Conservative operations upon the Fallopian tubes or ovaries. (v) A preliminary to the performance of vaginal hysteropexy. (vi) Those cases in which the patient’s general condition is unfavourable to the performance of exploration by the abdominal route. Anterior colpotomy is more suitable for removing small tumours growing from the anterior wall of the uterus, or for conservative operations on the ovaries. Posterior colpotomy is more suitable for removing inflamed appendages, and for evacuating collections of pus or blood from Douglas’s pouch. [Illustration: FIG. 47. POZZI’S RETRACTORS.] Posterior colpotomy has been used for many years for the opening of abscesses and hæmatoceles in Douglas’s pouch. The anterior operation is of more recent date, and its relative advantages and disadvantages and the indications for its use have not yet been definitely agreed upon by the majority of gynæcologists. Taking all things into consideration, the disadvantages of colpotomy seem to outweigh its advantages, and, except for the evacuation or drainage of collections of blood or pus behind the uterus, the operation may be said to have few indications.