title: Total Vaginal NOTES Hysterectomy: A New Approach to Hysterectomy.
abstract: The aim of this study was to demonstrate the feasibility of a total hysterectomy performed entirely by transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Conventional, reusable laparoscopic instruments were used, inserted through an inexpensive, self-constructed single-port device. Ten total vaginal NOTES hysterectomies (TVNHs) were performed by a single surgeon. The self-constructed single-port device was made by assembling a surgical glove, a wound protector or modified laryngeal mask airway, 1 reusable 10-mm trocar, and 4 reusable 5-mm trocars. This gloveport was inserted into the vagina to create a pneumovagina. The conventional steps of a vaginal hysterectomy were followed, but performed endoscopically with standard reusable endoscopic instruments. The patient and perioperative data were analyzed. No conversion to standard laparoscopy or laparotomy was necessary in any of the 10 patients who underwent a TVNH. Mean operation time was 97 min (range: 60-120); mean drop in hemoglobin level was 1.5 g/dL (range: 0.5-2.4). There were no operative complications, and postoperative pain scores were very low. This first report on a small number of patients demonstrates that TVNH is possible. By incorporating the advantages of endoscopic surgery, TVNH broadens the indications for vaginal hysterectomy and helps overcome its limitations. At the same time, the NOTES approach avoids abdominal wall wounds and trocar-related complications. TVNH is feasible, even when performed with reusable, conventional laparoscopic instruments. This frugally innovative technique also enables surgeons to perform hysterectomies by vNOTES in low resource settings.
authors.affiliation: Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium. Electronic address: jan.baekelandt@imelda.be.
authors.forename: Jan
authors.initials: J
authors.lastname: Baekelandt
mesh_terms: D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000295:instrumentation* / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery; D061646:Operative Time; D014621:Vagina / Q000601:surgery*
keywords: Frugal innovation; Hysterectomy; Low-cost, single-port device; NOTES; Standard reusable instruments; TVNH; Transvaginal; VAMIS; VANH; vNOTES