Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Hysterectomy in Women with Posterior Cul-de- sac Obliteration: A series of seven cases
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Abstract
Objectives: To describe the initial experience and surgical outcomes of the vaginal natural orifice transluminal endoscopic surgery (vNOTES) for hysterectomy (vNOTESH) in women with posterior cul de sac obliteration.
Case series: From December 2019 to February 2021, seven women who had indications of hysterectomy with or without a salpingo-oophorectomy at Bangkok Hospital Udon, Udonthani Province, Thailand, were recruited. All women had evidence of severe pelvic adhesion. Pelvic and recto-vaginal examinations revealed a fixed uterus with posterior cul de sac obliteration. In this type of women a wound retractor was placed within the vaginal flaps, and creation of pneumovagina, followed by an anterior colpotomy and serial steps of adhesiolysis and hysterectomy using an endoscope and endoscopic instruments.
Results: Application of a wound retractor and the anterior colpotomy were successfully done in all cases. The operation was converted to Total laparoscopic hysterectomy (TLH) in one woman because of severe adhesion. The median age and Body Mass Index (BMI) of the remaining six women were 44 years (range of 41-49), and 25.1 kg/m2 (range of 22-32.5), respectively. The median operative time and estimated blood loss (EBL) were 161 min (range of 116-215) and 350 ml (range of 150-800), respectively. One woman received a blood transfusion. There were no perioperative complications.
Conclusion: This case series demonstrated that the vNOTESH in women with posterior cul de sac obliteration is challenging, but feasible by a skillful surgeon. However, it was an initial experience; a study with a larger population should be conducted to evaluate the feasibility and safety.
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