Simplifying Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNOTES) in Ten Steps

Abstract

<h3>Study Objective</h3> To present an overview of Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNOTES) and to demonstrate a simple 10-Step approach based on our preliminary cases. <h3>Design</h3> Demonstration of VNOTES surgical technique. <h3>Setting</h3> Philippine tertiary training hospital. <h3>Patients or Participants</h3> Women undergoing Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNOTES) for benign indications. <h3>Interventions</h3> Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNOTES) adnexal procedures and hysterectomy. <h3>Measurements and Main Results</h3> Learning VNOTES can be quite daunting even for the most experienced laparoscopic surgeon. We will present ten simple steps that helped us in our VNOTES journey. These include: (1) insertion of anterior and posterior retractor, (2) infiltration of epinephrine, (3) posterior colpotomy (and anterior colpotomy for hysterectomy), (4) positioning of the port, (5) placement of cherry ball, (6) placement of port cover, trocars and creation of pneumoperitoneum, (7) proceed with adnexal procedure/hysterectomy, (8) removal of the specimen, (9) removal of cherry ball, trocars, and port (10) suturing of vaginal cuff or posterior cul-de-sac. <h3>Conclusion</h3> Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNOTES), although safe and feasible, is a daunting procedure for surgeons who are beginning to perform it. We hope that these ten simple steps will help guide future surgeons interested in performing Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNOTES) surgery.