Natural orifice surgery (NOS)--toward a single-port transdouglas approach for intra-abdominal procedures

The Renaissance of the Vaginal Hysterectomy-A Due Act

For many years, vaginal and abdominal hysterectomies were part of the routine procedures in many departments. Both of them lost their priority due to the introduction of endoscopy and robotic surgery. The disappearing abdominal hysterectomy is certainly reasonable, but the decline of using vaginal hysterectomy seems not to be justified, and it is an optimal example of the recent emergence of the Natural Orifice Surgery discipline. A modified method for vaginal hysterectomy is presented in order to encourage gynecologists to reconsider vaginal hysterectomy as a valid method. This method is the outcome of critical analyses of different vaginal hysterectomy methods. It is simple, reasonable, only ten steps, easy to learn, perform and teach, and proven to be a shorter operation with minimal blood loss and reduced need for analgesics when compared to the traditional way. Endoscopy or robotic surgery is not available everywhere. Therefore, it is important that gynecologists in low-resource settings be familiar with this simple method.

Vaginal myomectomy is a safe and feasible procedure: a retrospective study of 46 cases

AIM

The aim of this study was to establish the feasibility and safety of vaginal myomectomy via posterior colpotomy in a series of consecutive procedures performed by one surgeon.

MATERIAL AND METHODS

We conducted a retrospective study in a tertiary care university hospital, involving 46 patients with symptomatic myomas and uteruses smaller than 16 gestational weeks and with no signs of pelvic disease. After a presurgical study, the patients underwent vaginal myomectomy. Characteristics of patients, position and size of myomas, operative data, intraoperative and postoperative complications, and length of hospital stay were recorded.

RESULTS

Forty-four women underwent vaginal myomectomy and conversion to laparotomy was required in two cases (4.3%). Two patients suffered from infertility and one of these achieved pregnancy after the procedure. The median size of myomas was 50 mm (range 16-81). In two cases a culdoscopy was performed with a flexible fiberoptic gastroscope to better evaluate size and localization of myomas. Thirty-two patients underwent vaginal myomectomy under general anesthesia and 12 under locoregional anesthesia. The median vaginal operating time was 70 min (range 30-120). The estimated hemoglobin loss was 0.70 g/dL (range 0.40-3.35 g/dL). No severe intraoperative complications occurred. The median duration of hospital stay was 1 day (range 1-6).

CONCLUSIONS

Vaginal myomectomy is a safe and feasible surgical procedure if performed by a well-trained, experienced surgeon.