CanSAGE 2022 | 49 – vNOTES Hysterectomy, Adnexectomy and Uterosacral Ligament Suspension: A Walk-through Guide
Objective: To provide a stepwise guide to performing vNOTES hysterectomy, adnexectomy and vault suspension, using two access platform methods. Methods: Narrated surgical video Results: Step-by-step walk-through is shown to demonstrate the successful completion of a hysterectomy, adnexectomy, and vault suspension. Use of a traditional glove platform and that of an advanced access system, the GelPOINT Access System® (Applied Medical, CA, USA), are illustrated. The surgical steps are summarized as: (1) colpotomy and abdominal entry; (2) transection of the uterosacral ligaments; (3) placement of an access platform; (4) upper abdominal survey; (5) transection of the uterine and cornual pedicles; (6) identification of the ureters; (7) bilateral salpingo-oophorectomy; (8) uterosacral ligament suspension; (9) cystoscopy; (10) vaginal vault closure and tying of the suspension sutures. Conclusion: vNOTES offers scar-free surgery, improved access to high pedicles and surgical fields, and a favourable recovery profile, making it an attractive surgical route in appropriate candidates.