Transvaginal Laparoscopy - Hybrid NOTES

Introduction: Endoluminal surgery such as "NOTES" has become one of the innovations in minimally invasive surgery. Technical difficulty in manipulation and lack of instrumentation specifically for this environment led to other practical approaches like Hybrid NOTES, which is combination of transluminal endoscopy and a few abdominal wall ports. We have developed an ultra-minimally invasive transvaginal laparoscopic technique for gynecologic procedures.

Material & Methods: For myomectomy and hysterectomy, only 2 small ports (5mm umbilical trocar and 3mm trocar- left lower quadrant) are placed. The procedure is performed the same as traditional laparoscopy. Only one 5mm port is required for our adnexectomy as another manipulation port is placed in the vagina to reduce abdominal trauma as much as possible. In these procedures a 5 or 10 mm distal chip flexible videoendoscope is introduced into the vaginal port and flexed 180 degrees. An image converter is used to produce a similar image to umbilical laparoscopy.

Results: All procedures were completed without a conversion to open laparotomy or a standard laparoscopic approach. The cosmetic result was excellent as the required incision for the hysterectomy and myomectomy is only 3mm in addition to the incision in the umbilicus, while the adnexectomy is almost scarless. Post-operative discomfort is reduced as a result of minimal abdominal wall incisions.

Discussion: Transvaginal laparoscopy demonstrates the potential of introducing novel approaches and instrumentation into the minimally invasive surgery environment.

Video by:

Masaaki Andou, MD PhD
Kurashiki Medical Center, Japan