Transvaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy Aided by Transcervical Instrumental Uterine...

Area of Science:

• Minimally Invasive Surgery
• Gynecological Endoscopy
• Surgical Techniques

Background:

• Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) offers a minimally invasive approach to hysterectomy.
• Challenges in vNOTES include maintaining adequate visualization and instrument control within the surgical field.

Observation:

• A transcervical instrument was utilized for uterine manipulation during vNOTES hysterectomy in a patient with adenomyosis.
• This manipulation provided crucial leverage, improved exposure of uterine attachments, and prevented uterine rotation.

Findings:

• The transcervical manipulation technique facilitated unimpeded use of the surgeon's hands for retracting surrounding structures like bowel and adnexa.
• The hysterectomy was completed successfully without complications, demonstrating the efficacy of the described technique.
• Estimated blood loss was minimal (55 mL), and the patient was discharged on postoperative day three.

Implications:

• Transcervical instrumental uterine manipulation is a valuable adjunct for enhancing safety and efficiency in vNOTES hysterectomy.
• This technique mitigates risks such as inadvertent thermal injury by deflecting uterine structures away from the instrument tip.
• The described method represents a feasible and safe advancement in gynecological endoscopic procedures.