Abstract
Video Objective To describe technique of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) of hysterectomy in a case of multiple fibroid uterus with the aid of transcervical instrumental uterine manipulation- ATRIUM technique. Setting Minimally invasive gynecological surgery department, Naval Multi Speciality Hospital, Jalgaon, India. Interventions Transvaginal natural orifice transluminal endoscopic surgery of hysterectomy. Conclusion During vNOTES hysterectomy, using a laparoscopy instrument placed transcervically into the uterus for manipulation gives a leverage that helps in good exposure of all uterine attachments. It prevents unintentional rotation of uterus and its attachments. Therefore, the surgeon is not required to use second hand for retraction of uterus during surgery. This allows surgeon to use second hand for retraction of bowel and adnexa. As the tip of instruments is not completely visible in vNOTES surgery, manipulation helps to deflect the uterus and its attachments away from important structures thus preventing inadvertent thermal damage from the tip of the instrument. This is a feasible and safe technique of vNOTES hysterectomy. To describe technique of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) of hysterectomy in a case of multiple fibroid uterus with the aid of transcervical instrumental uterine manipulation- ATRIUM technique. Minimally invasive gynecological surgery department, Naval Multi Speciality Hospital, Jalgaon, India. Transvaginal natural orifice transluminal endoscopic surgery of hysterectomy. During vNOTES hysterectomy, using a laparoscopy instrument placed transcervically into the uterus for manipulation gives a leverage that helps in good exposure of all uterine attachments. It prevents unintentional rotation of uterus and its attachments. Therefore, the surgeon is not required to use second hand for retraction of uterus during surgery. This allows surgeon to use second hand for retraction of bowel and adnexa. As the tip of instruments is not completely visible in vNOTES surgery, manipulation helps to deflect the uterus and its attachments away from important structures thus preventing inadvertent thermal damage from the tip of the instrument. This is a feasible and safe technique of vNOTES hysterectomy.
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