Transvaginal natural oriﬁce transluminal endoscopic surgery: anewapproachtoovariancystectomy Jan Baekelandt, M.D. Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium Objective: To demonstrate a new approach for performing an ovarian cystectomy via transvaginal natural oriﬁce transluminal endo- scopic surgery (vNOTES) as an alternative for a laparoscopic ovarian cystectomy. Design: Stepwise explanation of the technique using original video footage. Setting: Hospital. Patient(s): Fourteen patients who provided informed consent and were treated transvaginally to remove a benign ovarian cyst. Intervention(s): The patient was placed in the lithotomy position under general anaesthesia. A 2.5-cm posterior colpotomy was made. The pouch of Douglas was opened and a transvaginal natural oriﬁce transluminal endoscopic surgery (vNOTES) port was inserted transvaginally. A pneumoperitoneum was created, and the ovarian cyst was identiﬁed. Conventional endoscopic instruments and a standard endoscope were inserted transvaginally through the vNOTES port. The ovarian cortex was incised over the cyst using cold scissors. The cyst was dissected from the ovarian cortex by a combination of blunt and sharp dissection. Ovarian hemostasis was achieved using bipolar forceps. The ovarian cyst was removed through the colpotomy in an endobag. The vNOTES port was removed, and the colpotomy was sutured using a resorbable suture. The following data were collected: age, body mass index, parity, number of previous abdominal procedures, ovarian cyst diameter, operating time, length of hospital stay, and visual analog scale score. Main Outcome Measure(s): Successful minimally invasive ovarian cystectomy via vNOTES without abdominal scars. Result(s): An ovarian cystectomy was successfully completed in all patients without conversions to standard laparoscopy, and no complications occurred. A fertility sparing cystectomy was performed via vNOTES in all patients; no ovariectomies were performed. All patients were discharged within 30 hours, and nine patients were discharged within 12 hours. Benign ovarian cysts can be treated by vNOTES through a posterior colpotomy via the pouch of Douglas. In a low-resource setting, a self-constructed gloveport and standard reusable endoscopic instruments can be used. In a ﬁrst-world setting the surgical time can be reduced using a commercially available vNOTES port. Conclusion(s): Transvaginal natural oriﬁce transluminal endoscopic surgery provides a new, less invasive approach for performing an ovarian cystectomy. This ﬁrst IDEAL (idea, development, exploration, assessment, long-term study) stage 1 study conﬁrms the feasibility of vNOTES ovarian cystectomy although it remains a novel approach that requires further investigation. It can provide improved patient comfort and better cosmetic results. (Fertil Steril 2018;109:366. 2017 by American Society for Reproductive Medicine.) Use your smartphone to scan this QR code Key Words: Cystectomy, natural oriﬁce transluminal endoscopic surgery, NOTES, ovary, and connect to the transvaginal, vNOTES video for this article now.* Discuss: You can discuss this article with its authors and other readers at https:// www.fertstertdialog.com/users/16110-fertility-and-sterility/posts/21613-25004 * Download a free QR code scanner by searching for “QR scanner” in your smartphone’s app store or app marketplace. tomy for ectopic pregnancy: a ﬁrst series 3. Lee CL, Wu KY, Su H, Ueng SH, Yen CH. Trans- AVAILABLE ON YOUTUBE demonstrating how a new surgical technique vaginal natural-oriﬁce transluminal endoscopic https://youtu.be/IUKS9XI2uyw can be applied in a low-resource setting. Gyne- surgery (NOTES) in adnexal procedures. J Minim col Surg 2015;12:299–302. Invasive Gynecol 2012;19:509–13. 2. Reynders A, Baekelandt J. Adnexectomy by SUGGESTED READING poor man’s transvaginal NOTES. Gynecol Surg 1. Van Peer S, Baekelandt J. Natural oriﬁce translu- 2015;12:207–11. minal endoscopic surgery (NOTES) salpingec- Received September 9, 2017; Revised October 25, 2017; accepted October 27, 2017; published online December 13, 2017. J.B. has nothing to disclose. Reprint requests: Jan Baekelandt, M.D., Department of Obstetrics and Gynaecology, Imelda Hospital, Imeldalaan 9, Bonheiden 2820, Belgium (E-mail: firstname.lastname@example.org). Fertility and Sterility® Vol. 109, No. 2, February 2018 0015-0282/$36.00 Copyright ©2017 American Society for Reproductive Medicine, Published by Elsevier Inc. https://doi.org/10.1016/j.fertnstert.2017.10.037 366 VOL. 109 NO. 2 / FEBRUARY 2018
Fertility and Sterility – Elsevier
Published: Feb 1, 2018
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