A.V. MALUSHKO¹, I.D. SHCHEDRINA¹, I.B. FATKULLINA², S.M. ALEKSEEV¹, E.M. ZULKARNEEVA², A.M. ZIGANSHIN³, O.V. SUVORINA¹, N.V. NAZARIKOVA¹, S.B. ONEGOVA¹, V.R. SILAKOVA⁴

 ¹Leningrad Regional Clinical Hospital, Saint Petersburg

²Republican Clinical Perinatal Center of the Republic of Bashkortostan, Ufa

³Sechenov First Moscow State Medical University, Moscow

Contact details:

Malushko A.V. — Head of the Gynecology Department

Address: 45 Lunacharskogo St., building 2, 194291 Saint Petersburg, Russian Federation, tel.: 8-800-301-47-47, e-mail: a-malushko@mail.ru

 Translumenal endoscopic surgery through natural orifices (vNOTES) is increasingly used in obstetric and gynecological practice. This technique successfully combines the advantages of both vaginal access and endoscopic interventions. vNOTES is a modern and advanced endoscopic surgical technique that provides access through the vagina without the need for incisions on the anterior abdominal wall or a cosmetic scar. This approach can serve as an excellent alternative to traditional surgery for vaginal hysterectomy, especially when simultaneous pelvic organ prolapse repair and uterine appendage removal (adnexectomy) are required.

The purpose is to describe and demonstrate our experience and standardized approach to performing vNOTES transluminal surgical interventions.

Material and methods. We performed 36 surgical interventions using v-NOTES technique in patients aged 33–65 y. o. in the Gynecology Department of Leningrad Regional Clinical Hospital. These included 5 myomectomies, 3 surgeries for infertility, 5 surgeries for benign appendage tumors, 11 pangysterectomies, 8 surgeries for pelvic organ prolapse, 2 tubectomies with adhesions, and 2 surgeries to correct uterine scarring after cesarean section.

Results. During 36 operations, no intraoperative or early postoperative complications occurred and no access conversions were required. At this stage, there is a slightly increased time for surgical interventions, which is quite justified while learning the new surgical technique, not only by the operating surgeon but also by the entire surgical team, and the time for operating nurses’ preparation is extended. However, we expect that this time will decrease afterwards. However, there is minimal pain and early discharge of patients.

Conclusions. The vNOTES technique allows significantly reducing postoperative pain and the length of stay in the hospital, maximizes the cosmetic effect, and provides a rapid recovery of patients after surgery. The technology is safe, which may reduce the risk of postoperative complications in patients with comorbidity. With the development of this technology, it can be introduced into a wider practice.

Key words: transluminal surgery, vNOTES, hysterectomy, endomcopic surgery, minimally invasive surgery, prospects

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