Pure vNOTES Contained Power Morcellation: First Report

Abstract

Study Objective To demonstrate a new technique of pure vaginal natural orifice transluminal endoscopic surgery (vNOTES) contained power morcellation of a transversely enlarged uterus in an endobag. Design Stepwise description of the technique with a narrated video. Setting Minimally invasive gynecological surgery department with experience in vNOTES at a tertiary care private hospital. Patients or Participants A 45-year-old female with a large fibroid uterus resulting in severe menorrhagia. Interventions The surgery is performed in the following manner and sequence- 1. Vaginally assisted NOTES hysterectomy for a large fibroid uterus. 2. Transvaginal insertion of VNMor Endobag (Veol Medical Technologies, Koparkhairane, Navi Mumbai- 400705, India) and bagging the specimen. 3. Application of vNOTES port to the VNMor Endobag followed by power morcellation of large uterus in bag using the Versator NOTES morcellator (Veol Medical Technologies, Koparkhairane, Navi Mumbai- 400705, India). Measurements and Main Results The duration of hysterectomy was 43 mins, the duration of power morcellation was 14.5 mins, and the duration of other steps was 17 mins. Blood loss was about 75 ml. The weight of the retrieved specimen was 906 grams. There was no conversion to laparoscopy or laparotomy. There were no intraoperative and postoperative complications. The patient was discharged on day 2. Conclusion Pure vNOTES contained power morcellation is a feasible new technique using new modified instrumentation. This technique can possibly reduce the time required for specimen retrieval through a narrow vagina. It has the potential to retrieve large uteri or masses transvaginally. However, this should be evaluated in further studies. To demonstrate a new technique of pure vaginal natural orifice transluminal endoscopic surgery (vNOTES) contained power morcellation of a transversely enlarged uterus in an endobag. Stepwise description of the technique with a narrated video. Minimally invasive gynecological surgery department with experience in vNOTES at a tertiary care private hospital. A 45-year-old female with a large fibroid uterus resulting in severe menorrhagia. The surgery is performed in the following manner and sequence- 1. Vaginally assisted NOTES hysterectomy for a large fibroid uterus. 2. Transvaginal insertion of VNMor Endobag (Veol Medical Technologies, Koparkhairane, Navi Mumbai- 400705, India) and bagging the specimen. 3. Application of vNOTES port to the VNMor Endobag followed by power morcellation of large uterus in bag using the Versator NOTES morcellator (Veol Medical Technologies, Koparkhairane, Navi Mumbai- 400705, India). The duration of hysterectomy was 43 mins, the duration of power morcellation was 14.5 mins, and the duration of other steps was 17 mins. Blood loss was about 75 ml. The weight of the retrieved specimen was 906 grams. There was no conversion to laparoscopy or laparotomy. There were no intraoperative and postoperative complications. The patient was discharged on day 2. Pure vNOTES contained power morcellation is a feasible new technique using new modified instrumentation. This technique can possibly reduce the time required for specimen retrieval through a narrow vagina. It has the potential to retrieve large uteri or masses transvaginally. However, this should be evaluated in further studies.