How To Avoid Laparotomy during Hysterectomy

Abstract

Study Objective: Preliminary advances in s natural orifice transluminal endoscopic surgery (NOTES) as applied to urologic and gastrointestinal surgery demonstrate that the techniques are feasible provided that both optimal surgical technical expertise with advanced skills and optimal instrumentation are available. Vaginal hysterectomy is a procedure for small size or prolapsed uterus; but laparoscopic-assisted vaginal hysterectomy (LAVH) is for moderate size and non-prolapsed uterus. It is reasonable to perform vaginal NOTES hysterectomy for moderate size and non-prolapsed uterus. Design: Prospective clinical study. Setting: Teritary university teaching medical center. Patients: From August 2011 to March 2012, eight patients underwent transvaginal NOTES of hysterectomy in one single operative setting. Intervention: Transvaginal NOTES of hysterectomy and bilateral Salpingoovariectomy. Measurements and Main Results: Eight patients underwent transvaginal NOTES of hysterectomy. Five were identified as Female to Male (FtM) transsexuals. The transsexuals were younger (22-45 years. median 27 years), with no parity (P0).The operating times were 70-120minutes (median 80 minutes). Blood loss during surgery (100-650mL, median 200 mL). There was no complication after surgery. We also showed the video of vaginal NOTES surgery in this presentation. Conclusion: Transvaginal natural orifice transluminal endoscopic surgery (NOTES) hysterectomy and bilateral Salpingoovariectomy for female-tomale transsexuals seems a safe, feasible, and valuable procedure for FtM transsexuals.