Transvaginal Natural Orifice Transluminal Endoscopic Surgery with a Self-Constructed Pessary Port

Abstract

Study Objective To describe a low-cost self-constructed pessary port for Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and to demonstrate the feasibility of several procedures using the port. Design Description of the port and demonstration of its clinical applications using surgical video footage. Setting A tertiary university hospital. Patients or Participants 2 patients with gender identity disorder, 1 patient with pelvic organ prolapse, 1 patient with tubal ectopic pregnancy, 1 patient with dermoid cyst, 1 patient with type 6 myoma. Interventions A patient with gender identity disorder underwent vNOTES bilateral salpingo-oophorectomy following vaginal hysterectomy. A patient with gender identity disorder underwent vNOTES assisted vaginal hysterectomy due to difficulty during conventional vaginal hysterectomy because of increased uterine size related to fibroids. A patient with pelvic organ prolapse underwent high uterosacral ligament suspension following vaginal hysterectomy. A patient with tubal ectopic pregnancy underwent unilateral salpingectomy. A patient with a 5-cm dermoid cyst underwent ovarian cystectomy. A patient with a 5.5-cm type 6 myoma underwent myomectomy. Measurements and Main Results N/A Conclusion vNOTES is a new form minimally of invasive surgery which has been gaining momentum through the last decade. However, it would not be wrong to say that it is still not widespread. This fact may stem from the belief that special equipment designed exclusively for vNOTES is required to perform vNOTES procedures. The port described in this video can be easily built using a ring pessary, and basic equipment available in almost every operating room. As demonstrated in the video, a variety of gynecological surgeries can be carried out using the port with the existing laparoscopic setting. This video may aid vNOTES in getting more exposure as it describes a low-cost, effective and highly available tool suitable for most of the common gynecological procedures.