First experiences in Switzerland with total hysterectomy by transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES). A single-patient case video

Aim of the study We present the first experience in Switzerland of hysterectomy by transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES).

Materials and methods A 52 years old patient with abnormal uterine bleeding type FIGO AUB-L and history of laparoscopic myomectomy and sacrocolpopexy with mesh demanded hysterectomy. Total hysterectomy was performed using the vaginally assisted NOTES hysterectomy (VANH) technique. Anterior and posterior intra-abdominal access was created classically. Insertion of a wound protector covered by an access port (GelPoint, Applied Medical) was done to create a pneumovagina and a pneumoperitoneum, consequently. Dissection was performed using a bipolar vessel sealer and usual laparoscopic instrument. Vaginal cuff closure is similar to classic vaginal hysterectomy.

Results Operative time was 110 min and patient stay at the hospital was one night. No complications occurred during or after the procedure.

Conclusion Hysterectomy using the VANH technique is feasible and offers an alternative to women in whom standard vaginal or laparoscopic hysterectomy is risky because of uterine size and abdominal procedures might not be recommended because of patient history.

Publication History

Article published online:
07 October 2020