Ten tips of vNOTES hysterectomy for a novice

Authors:Chun-Hui Wei 1; Kun-Ta Ho 1; Nari Kay2; Yu Chang2; Tae-Joong Kim3
Affiliations:Chi Mei Medical Center, Liouying 1; E-DA Hospital 2; Samsung Medical Center, Republic of Korea3

Ten tips of vNOTES hysterectomy for a novice

Material & Methods:
This 50 y/o female, P2 (VD), suffered from heavy menstrual bleeding and prolonged period for 2 years. Transvaginal ultrasound (TVU) showed an intramural myoma of 5 cm at posterior wall and an endometrial polyp of 2 cm. Pelvic examination revealed uterine prolapse (stage I) and no pelvic adhesion. She has no history of abdominal operation. She was scheduled for vNOTES hysterectomy.

The operation time was 90 minutes. Weight of specimen was 162.8g, and blood loss was minimal. There was no operative complication. The patient was discharged in the next morning after operation. The hospitalization was just one day. Ten tips are as follows: 1) pre-operative TVU survey for Cul-de-sac 2) find the cutting junction of anterior and posterior fornix 3) retroperitoneal approaching skill 4) cut uterosacral ligament as early as possible for pulling down the uterus 5) the safe sharp dissection width of vesicocervical ligament 6) tip to set up the wound retractor 7) avoid torsion of wound retractor 8) cervical amputation 9) push the uterus up instead of pulling down and 10) turn the uterus for more operative space.

vNOTES hysterectomy has several possible advantages, such as less pain, faster recovery, shorter hospital stays and no scar on the abdomen. The thresholds of NOTES hysterectomy can be overcome by 10 tips.