Transvaginal laparoscopy

Abstract

Transvaginal laparoscopy (TvL) offers an alternative to standard diagnostic laparoscopy in subfertile patients without obvious pelvic pathology. With a specially developed needle-trocar system, access to the pouch of Douglas is gained through a needle puncture of the posterior fornix. Performed under local anaesthesia or sedation with the patient in a dorsal decubitus position and using prewarmed Ringer lactate as a distension medium, TvL allows complete exploration of the tubo-ovarian structures without supplementary manipulation. The combination of transvaginal sonography and transvaginal endoscopy, including minihysteroscopy, TvL, salpingoscopy and chromopertubation test, permits the most complete exploration of the reproductive tract and can be used as a first-line investigation of female fertility in a one-stop infertility clinic. As the transvaginal route offers easy access to the tubes, ovaries and fossa ovarica, some operative procedures are possible. However, in the absence of a panoramic view, these will be limited to minor interventions.

Hybrid NOTES transvaginal cholecystectomy: operative and long-term results after 18 cases

“…Careful preoperative psychological and physical screening is of paramount importance in order to exclude women with subjacent sexual problems and/or gynaecological diseases. Regarding the risk of injury of hollow viscus, it is very low even in the absence of direct laparoscopic visualisation, comprising between 0.25% and 0.65% [11]. Anyway, we had rather carry out colpotomy under direct control by a 5-mm minilaparoscope to prevent visceral injuries, as reported by others [14,15].…”

“…Dissection of biliary structures was successfully achieved by hybrid NOTES technique in four obese patients, and one specific difficulty encountered in these obese patients was the performance of colpotomy owing to the thickness of the properitoneal fat layer. The average duration of colpotomy was 10 min (range [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The average duration of the whole NOTES procedure, from introduction of the gastroscope to closure of colpotomy, was 75 min (range 40-190).…”

“…In the field of laparoscopic general surgery, the transvaginal route has been used for the extraction of large specimens (gallbladders, spleen, colon, kidney) with minimal complications [30]. Tsin in 2001 reported the first series of laparoscopic procedures successfully performed through the vagina for gynaecological diseases [11]. In 2003, Tsin [12] reported the first case of cholecystectomy performed through the vagina during a vaginal hysterectomy, and some studies have tested the natural orifice approach for ablation of the gallbladder also in obese patients [18,19].…”

“…At the same time, the experience gained in experimental settings has shown that with currently available technology, the operative tasks in the upper part of the abdomen are better accomplished by endoscopes coming from natural orifices located in the pelvis [8][9][10]. In this scenario, the transvaginal access has eventually been considered as the most suitable for clinical applications, also thank to the vast experience already provided by gynaecologists who have performed diagnostic and therapeutic procedures through this route [11,12]. The first report of transvaginal cholecystectomy in a human being, carried out during a vaginal hysterectomy, dates back to 2003 and was by the American gynaecologist D. Tsin from Mt.…”

Partial gastrectomy using natural orifice translumenal endoscopic surgery (NOTES) for gastric submucosal tumors: early experience in humans

“…It is relatively independent of advanced technology development, with a potential benefit of easy decontamination, controllable access, and easy closure under direct vision [2,3,9]. The safety of the transvaginal route also has been well documented for numerous gynecologic procedures [10,11]. In addition, the transvaginal route seems logical for most upper abdominal NOTES procedures because it may provide straight visualization and could possibly enhance maneuverability of endoscopic instruments to the upper abdominal organs.…”