To demonstrate vNOTES approach for excision of deep infiltrating endometriosis during hysterectomy

Design:

A step by step narrated video.

Setting:

Tertiary care hospital.

Patients or Participants:

A 49 year old female with polymenorrhagia from 5 years and severe dysmenorrhoea (VAS- 7/10), low backache (VAS- 5/10) from 3 years. She had history of failed medical management.

Interventions:

vNOTES hysterectomy with right salpingo-oophorectomy, left salpingectomy and excision of deep infiltrating endometriosis.

Measurements and Main Results:

The duration of the surgery was 128 minutes. Blood loss was about 145 ml. There were no intraoperative or postoperative complications. The patient was discharged on day 3.

Conclusion:

vNOTES can provide adequate visualisation in selected cases of mild to moderate endometriosis. It is possible to do retroperitoneal dissection by vNOTES for identification and safeguarding important structures. However, in cases of severe endometriosis, the anatomy may be significantly distorted, making vNOTES approach difficult and prone to complications. Further studies are needed to validate feasibility of vNOTES endometriosis excision.