Transvaginal Natural Orifice Transluminal Endoscopic (vNOTES) Hysterectomy: A Novel Route for Uterus Removal

Abstract

Study Objective To demonstrate the feasibility of Transvaginal Natural Orifice Transluminal Endoscopic (vNOTES) hysterectomy. Design Stepwise demonstration with narrated surgical video. Setting A university-affiliated center. Patients or Participants A 52-year-old gravida 2, para 2 woman with a 10 cm fibroid presented with a 2-year history of frequent micturition. Ultrasound showed fibroids and bilateral ovarian cysts. Interventions After injecting dilute vasopressin in the cervix, the vaginal mucosa was incised circumferentially. Posterior and anterior colpotomy was made. Then bladder pillars were clamped. Single-site port was successfully placed and pneumoperitoneum was established. After the survey of upper abdomen, progressive clamping from the cardinal ligaments to the level of the broad ligament was performed. Then the proper ligaments of ovary were clamped and bilateral oophorosalpingectomy was performed. The specimen was then delivered to the vagina. The vaginal cuff was closed with running stich. Measurements and Main Results The surgery was successfully conducted with operating time of 120 minutes and blood loss of 20 ml. The uterus weighed 410 g. The patient recovered well and had resolution of frequent micturition. Conclusion vNOTES is feasible for hysterectomy. Combined with traditional transvaginal colpotomy, vNOTES allows the access to the entire abdomen and completion of hysterectomy through a transvaginal single port. Transvaginal NOTES Hysterectomy benefits specimen removal and leads no abdominal incision.