Pure Transvaginal Natural Orifice Transluminal Endoscopic Surgery Of Hysterectomy. During vNOTES hysterectomy, using an instrument placed transcervically into the uterus for manipulation gives a leverage that helps in good exposure of all uterine attachments. It prevents unintentional rotation of uterus and its attachments. Therefore surgeon is not required to use second hand for retraction of uterus during surgery. This allows surgeon to use second hand for retraction of bowel and adnexa. As the tip of instruments is not completely visible in vNOTES surgery, manipulation helps to deflect the uterus and its attachments away from important structures thus preventing inadvertent thermal damage from the tip of the instrument. This is a feasible and safe technique of vNOTES hysterectomy.
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