Simplifying Transvaginal Natural Orifice Transluminal Endoscopic Surgery with a Two-Step Technique

Abstract

Study Objective To describe a two-step technique which facilitates Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and to demonstrate the feasibility of the technique in different conditions. Design Description of the technique and demonstration of its performance using surgical video footage. Setting A tertiary university hospital. Patients or Participants 3 patients with tubal ectopic pregnancy, 1 patient with pregnancy of unknown location, 1 patient with paraovarian cyst. Interventions At the beginning of the video, using surgical video footage from a case of tubal ectopic pregnancy, we demonstrated the performance of a posterior colpotomy for VNOTES in a classic fashion. Following that, our two-step technique was demonstrated in detail using surgical video footage from 2 cases of ectopic pregnancy, with one of them having significant hemoperitoneum. Both of these patients underwent unilateral salpingectomy. At the end of the video, two other cases treated using the technique were briefly demonstrated; a patient with pregnancy of unknown location who underwent a diagnostic vNOTES alone (step 1 only) and a patient with a 10-cm paraovarian cyst who underwent cystectomy. Measurements and Main Results N/A Conclusion Advancements in minimally invasive surgery go in parallel with innovations and advancements in technology. However, improvements in existing techniques and utilization of new techniques are also crucial components of advancement. Based on our own experience with vNOTES and the existing knowledge about transvaginal hydrolaparoscopy (TVHL), we described the two-step technique demonstrated in this video. We believe that this technique may be beneficial to make vNOTES more widespread as it allows both diagnostic and therapeutic procedures to be carried out in a faster and safe manner without the need for any special equipment and without increasing the costs.