A Bladder-Saving Technique in vNOTES: Uterine Twisting Maneuver for Patients With Previous Cesarean Sections

Area of Science:

• Gynecology
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) offers minimally invasive hysterectomy.
• Bladder injury is a known complication, heightened by previous cesarean sections and altered pelvic anatomy.
• Standard vNOTES techniques may not adequately address anatomical complexities.

Purpose of the Study:

• To present a novel bladder-saving technique during vNOTES hysterectomy.
• To demonstrate the utility of the "uterine twisting maneuver" in managing complex pelvic anatomy.
• To enhance the safety profile of vNOTES hysterectomy in at-risk populations.

Main Methods:

• Video demonstration of a vNOTES hysterectomy.
• Implementation of the innovative "uterine twisting maneuver" to optimize bladder protection.
• Focus on cases with a history of cesarean sections and complex pelvic anatomy.

Main Results:

• Successful execution of vNOTES hysterectomy utilizing the uterine twisting maneuver.
• Effective protection of the bladder from injury during the procedure.
• Demonstrated feasibility in a patient with complex anatomy due to prior cesarean sections.

Conclusions:

• The uterine twisting maneuver is a valuable technique for bladder preservation during vNOTES hysterectomy.
• This approach is particularly beneficial for patients with challenging pelvic anatomy.
• The technique represents a significant advancement in vNOTES surgical practice.