Design: Narrated video footage

Setting: single academic institution

Patients or Participants:

Case 1 is a 30 yo G7P4115 who presents desiring permanent sterilization via vNOTES salpingectomy. Her surgical history was complicated by a cornual ectopic pregnancy, treated with laparoscopic cornual wedge resection and right salpingectomy in 2011 at an outside hospital. In 2023, she suffered a cornual uterine rupture in her subsequent pregnancy at 19w2d, which was repaired by exploratory laparotomy, reduction of prolapsed fetal membranes, and repair of the 2cm uterine rupture. She progressed with the pregnancy and underwent a preterm primary Cesarean section at 33w1d for absent myometrial tissue found on US. Intraoperatively, she had a 5cm complete cornual uterine rupture. She underwent repair of this defect, and was discharged home with a Nexplanon with plans for an interval vNOTES bilateral salpingectomy for permanent sterilization.

Case 2 is a 29 yo G2P2 who desires permanent sterilization, who failed bilateral salpingectomy at time of previous Cesarean section due to significant adhesive disease. She underwent complete permanent sterilization with interval vNOTES bilateral salpingectomy

Interventions: (1) We demonstrate the process for use and placement of the transvaginal access platform for vNOTES adnexectomy. (2) We perform an abdominal survey to assess adhesion disease and any abdominal pathology. (3) Salpingectomy is performed via the single-site transvaginal access platform.

Measurements and Main Results: n/a

Conclusion: We demonstrate that vNOTES is a safe, alternative technique compared to traditional laparoscopy for patients with a history of complex abdominal surgeries desiring permanent sterilization. VNOTES can be considered in patients with suspected adhesive disease from prior abdominal surgeries.