Vnotes: a vaginal approach to laparoscopic hysterectomy and prolapse repair

Abstract

The objective of this video is to describe the set-up, execution, and advantages of laparoscopy via a vaginal approach for hysterectomy and pelvic organ prolapse repair. This video details the case of a 63-year-old patient with stage II symptomatic pelvic organ prolapse and mixed urinary incontinence. She had a history of prior pelvic surgery including a sigmoid colectomy and reanastomosis and strongly desired hysterectomy and bilateral salpingo-oophorectomy at the time of her prolapse repair. Laparoscopic assisted vaginal hysterectomy, bilateral salpingo-oophorectomy (BSO), and uterosacral ligament vaginal vault suspension were performed via the vNOTES procedure. Technique, equipment, set-up, and strategies for success are described throughout the video. Pelvic anatomy from a vaginal vantage point is highlighted and a direct view during crucial points of each procedure is provided. Laparoscopic techniques including lysis of adhesions and retroperitoneal exploration are detailed in the video as a result of her prior surgery. This video demonstrates the equipment and feasibility of vaginal laparoscopy and highlights the advantages of increased visualization during difficult vaginal surgery.