To demonstrate transvaginal natural orifice transluminal endoscopic surgery (vNOTES) technique of hysterectomy in a case with large broad ligament fibroid.

Design:

A step by step narrated video.

Setting:

Tertiary care hospital

Patients or Participants:

A 43 year old female with complaints of pain in lower abdomen (VAS- 5/10) from 4 months. She had history of one normal vaginal delivery and one cesarean section.

Interventions:

vNOTES hysterectomy with bilateral salpingectomy followed by contained retrieval of specimen.

Measurements and Main Results:

The duration of the surgery was 194 minutes and total blood loss was about 230 ml. The specimen weighed 1.645 Kg. The patient was discharged on day 3 without any complications.

Conclusion:

vNOTES is a feasible minimally invasive technique of hysterectomy for removal of even large uteri as the endoscopic vision allows the surgeon to tackle difficulties in removing large specimen. Only surgical teams with significant experience in vNOTES should do such procedures.