Transvaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy in a Woman with Uterine Adenomyosis and Multiple Severe Abdominal Adhesions

Abstract

Natural orifice transluminal endoscopic surgery (NOTES) had been used for many gynecologic surgeries without pelvic adhesions. We report a 30-year-old female with multiple abdominal adhesions underwent NOTES hysterectomy successfully. A 30-year-old female (para 2, gravida 3, abortus 1) presented with menorrhagia and dysmenorrhea. She had multiple abdominal surgical histories. Computed tomography scan revealed multiple adhesions between the abdominal wall and small intestine. On pelvic ultrasonography, an enlarged uterus 8.3 cm × 3.5 cm with adenomyosis was visualized. Because of the extensive intra-abdominal adhesions, we decided to use a transvaginal NOTES approach to perform hysterectomy. We performed the surgery successfully without complication. Pathological examination confirmed adenomyosis of uterus. NOTES hysterectomy may be feasibly and safely performed in gynecologic patients with extensive abdominal adhesions.

Keywords: Abdominal adhesions; hysterectomy; natural orifice transluminal endoscopic surgery.

Figure 1

Image studies of the patient. (a) Coronal view of computed tomography of the abdomen. Note severe adhesions between the intestine and abdominal wall. (b) Sagittal view of computed tomography of the abdomen. Star sign showed intestine adhered to the right posterior surface of the uterus. U: Uterus. (c) Coronal view of the adhesion site. (d) Transvaginal ultrasonography of the uterus

Figure 2

The natural orifice transluminal endoscopic surgery operative images in hysterectomy. (a) Transvaginal natural orifice transluminal endoscopic surgery portal. The anterior and posterior colpotomy was protected by Alexis wound retractor. A surgical glove with four cannulas attached was draped into the retractor. (b) Exploring the left parametrial space and had cutting the uterine artery. (c) Exposure the left adnexal region. (d) Exploring the right adnexal region. (e) Severe pelvic adhesions between the small intestine and right fundal region of the uterus. (f) After dissecting the adhesions. “http://www.apagemit.com/page/video/show.aspx?num=172&kind=7&page=1”