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. 2017 Oct-Dec;6(4):195-198.
doi: 10.1016/j.gmit.2017.02.005. Epub 2017 May 4.

Subtotal hysterectomy by natural orifice transluminal endoscopic surgery

Chyi-Long Lee  1   2 , Kai-Yun Wu  3   2 , Chen-Ying Huang  3   2 , Chuan Cheng  3 , Chien-Min Han  3   2 , Chih-Feng Yen  3   2
Affiliations

Subtotal hysterectomy by natural orifice transluminal endoscopic surgery

Chyi-Long Lee et al. Gynecol Minim Invasive Ther. 2017 Oct-Dec.

Abstract

Study objective: To introduce the innovative surgical procedure of treating benign uterine pathology with subtotal hysterectomy by natural orifice transluminal endoscopic surgery (NOTES).

Design: Prospective observational study.

Setting: Tertiary referral medical center.

Methods: From June 2014 to May 2016, three patients with benign uterine diseases who were eligible for laparoscopic subtotal hysterectomy were recruited to undergo transvaginal NOTES at a tertiary referral medical center. Intraoperative and postoperative surgical outcomes were measured.

Results: Subtotal hysterectomy by transvaginal NOTES was successfully completed in all patients without any conversion to conventional laparoscopy. The operative time was 144 ± 4.5 (138-149) minutes with an average estimated blood loss of 133 ± 62 (50-200) mL. None of the patients required an intraoperative blood transfusion. The mean specimen weight was 140 ± 59 (56-188) g. The final histology reports were uterine leiomyoma and adenomyosis in these three cases. There were no intraoperative or postoperative complications. No case required intraoperative or postoperative blood transfusion. No cases were converted to traditional laparoscopy or laparotomy.

Conclusion: Our preliminary results showed the safety and feasibility of subtotal hysterectomy by transvaginal NOTES in selected patients. It is one of the most minimally invasive surgeries and results in invisible scars.

Keywords: laparoscopic hysterectomy; laparoscopy; myoma uteri; natural orifice transvaginal endoscopic surgery (NOTES); subtotal hysterectomy.

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Conflict of interest statement

Conflicts of interest: All contributing authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) A Lagiport kit multiple instrument access port (Lagis Enterprise Co., Ltd., Taichung, Taiwan) was inserted into vagina with its inner rim fixed against the posterior wall of the uteri and posterior cul-de-sac. (B) The insufflating tube was connected to one of the cannulas to establish pneumoperitoneum.
Figure 2
Figure 2
Intraoperative photographs from a representative patient showing portions of the endoscopic procedures. (A) The right ovarian ligament was exposed then dissected by the LigaSure. (B) Cervix stump was closed with 1–0 Vicryl. (C) Posterior colpotomy was approximated.
See this image and copyright information in PMC

References

    1. Lee CL, Wu KY, Su H, Wu PJ, Han CM, Yen CF. Natural orifice transluminal endoscopic surgery (NOTES) in gynecology. Gynecol Minim Invasive Ther. 2012;1:23–26.
    1. Lee CL, Wu KY, Su H, Ueng SH, Yen CF. Transvaginal natural-orifice transluminal endoscopic surgery (NOTES) in adnexal procedures. J Minim Invasive Gynecol. 2012;19:509–513. - PubMed
    1. Lee CL, Wu KY, Su H, Yen CF, Ueng SH. Regarding “transvaginal single-port natural orifice transluminal endoscopic surgery”. J Minim Invasive Gynecol. 2013;20:131–132. - PubMed
    1. Su H, Yen CF, Wu KY, Han CM, Lee CL. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES):feasibility of an innovative approach. Taiwan J Obstet Gynecol. 2012;51:217–221. - PubMed
    1. Lee CL, Wu KY, Su H, Wu PJ, Han CM, Yen CF. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (NOTES):a series of 137 patients. J Minim Invasive Gynecol. 2014;21:818–824. - PubMed

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