![]() In rare cases, the vaginal opening is closed. However, it was an initial experience, a study with a larger population should be conducted to evaluate the feasibility and safety. In some cases, where the uterus is exerting undue pressure on the vagina, a hysterectomy may be recommended. There were no perioperative complications.Ĭonclusion: This case series demonstrated that the vNOTESH in women with posterior cul de sac obliteration is challenging, but feasible by a skillful surgeon. The median operative time and EBL were 161 min (range of 116-215) and 350 ml (range of 150-800), respectively. The median age and BMI of the remaining six women were 44 years (range of 41-49), and 25.1 kg/m2 (range of 22-32.5), respectively. The operation was converted to TLH in one woman because of severe adhesion. Results: Application of a wound retractor and the anterior colpotomy were successfully done in all cases. In this type of women a wound retractor was placed within the vaginal flaps, and creation of pneumovagina, followed by an anterior colpotomy and serial steps of adhesiolysis and hysterectomy using an endoscope and endoscopic instruments. No extension to the level of the rectovaginal septum. Pelvic and recto-vaginal examinations revealed a fixed uterus with posterior cul de sac obliteration. This type endometriosis is a retrocervical and rectal disease with involvement of the vagina in most cases. All women had evidence of severe pelvic adhesion. Materials and Methods: From December 2019 to February 2021, seven women who had indications of hysterectomy with or without a salpingo-oophorectomy at Bangkok Hospital Udon, Udonthani Province, Thailand, were recruited. Objective: To describe the initial experience and surgical outcomes of the vNOTES for hysterectomy (vNOTESH) in women with posterior cul de sac obliteration.
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