How to Avoid Bowel Injury During vNOTES Operation

This video showcases a vNOTES (Vaginal Natural Orifice Transluminal Endoscopic Surgery) hysterectomy performed on a high-risk patient with a history of: 3 prior cesarean sections.2 laparotomies. BMI of 49 (morbid obesity). Chronic Obstructive Lung Disease (COPD).The focus of this video is on intraoperative tips and tricks to minimize the risk of bowel injury, particularly in patients with significant surgical and medical complexities.

Key aspects include:

Preoperative assessment of adhesions and surgical planning.Techniques for safe adhesiolysis to separate bowel from the uterus.Effective use of barriers (e.g., gauze, retractors) to shield the bowel.Strategies to optimize visualization and maintain a clear operative field.Precautions with electrosurgical devices to prevent thermal injury.Stepwise dissection to identify and protect critical anatomical structures.This case provides practical insights for gynecologic surgeons to safely navigate challenging anatomy and reduce bowel-related complications in minimally invasive surgery.

Watch for expert surgical techniques and pearls for safer vNOTES procedures.