A Novel Approach to Combined Vaginal and Laparoscopic Gynecological Surgery

Abstract

Background and Objectives: In this case series, we propose a novel approach to combined vaginal and laparoscopic surgery in which a posterior colpotomy and 2 5-mm abdominal incisions are used to perform benign gynecological procedures. We seek to assess the safety and feasibility of this technique in difficult surgical candidates such as those with obesity or prior laparotomies, as well as to detail intra- and postoperative complications associated with the procedure. Methods: We collected demographic, clinical, intra-operative, and postoperative data on 45 women who underwent a combined vaginal and laparoscopic gynecological surgery for benign indications by a single surgeon between February 2013 and August 2017. Results: From February 2013 through August 2017, 45 women underwent a combined vaginal and laparoscopic surgery at 2 institutions. Procedures included adnexal surgery (n = 32, 71%), and total hysterectomy (n = 13, 29%). Of patients who underwent adnexal surgery, two had minor postoperative complications. No patients had major complications. In addition, no patients had postoperative vaginal infections or pelvic abscesses, and there were no readmissions within 30 days after the procedures. Conclusion: Our proposed combined vaginal and laparoscopic approach to benign gynecological surgery can be utilized in difficult surgical candidates including those with obesity, nulliparous patients, and those with prior abdominal surgery. Our data has shown that this approach is safe and effective.

Comparison of novel two‐port and conventional multiport laparoscopic surgery approaches for benign adnexal masses: The Bagli method

“…13 Conventional laparoscopic oophorectomy or salpingectomy is one of the most commonly performed surgical methods, whereby it generally involves three or more trocar ports, meaning that surgeons create three or more incisions on the abdominal skin; in addition, some surgeons also use cul-de-sac incisions. 4,7,14 Despite many criticisms for violating the basic rules of conventional multiport laparoscopy, reduced port laparoscopy such as TPLS offers potential benefits, which may include decreased postoperative pain, improved cosmesis, fewer trocar sites and wound-related complication and increased postoperative satisfaction. 15 In addition to endoscopic gynecologic surgery, other surgical departments such as urology, general surgery and thoracic surgery also described TPLS (two abdominal incisions and some authors performed additional trocar placement in vagina or at the same umbilical incision) in their treatment area.…”

“…15 In addition to endoscopic gynecologic surgery, other surgical departments such as urology, general surgery and thoracic surgery also described TPLS (two abdominal incisions and some authors performed additional trocar placement in vagina or at the same umbilical incision) in their treatment area. 7,[15][16][17][18] However, our two-port technique is different from the others because only two instruments are used by a surgeon at the same time: an optic in one hand and an energy device (with grasp, burning and cut functions) in the other hand, so total incision is smaller according to others. For example, Song et al published a study that included two-port surgery; they used a home-made port (how many mm is unknown) at the umbilicus for the multichannel method and one 5-mm port at the suprapubic area, so they used three instrument.…”

“…Minimally invasive techniques for gynecologic surgery developed rapidly within a span of 50 years 13 . Conventional laparoscopic oophorectomy or salpingectomy is one of the most commonly performed surgical methods, whereby it generally involves three or more trocar ports, meaning that surgeons create three or more incisions on the abdominal skin; in addition, some surgeons also use cul‐de‐sac incisions 4,7,14 . Despite many criticisms for violating the basic rules of conventional multiport laparoscopy, reduced port laparoscopy such as TPLS offers potential benefits, which may include decreased postoperative pain, improved cosmesis, fewer trocar sites and wound‐related complication and increased postoperative satisfaction 15 .…”

“…5 Currently, surgeons dealing with minimally invasive surgery are able to choose between conventional multiport laparoscopic surgery (CMLS), laparoendoscopic single-site (LESS) surgery, robotic LESS surgery, vaginal natural orifice transluminal endoscopic surgery (vNOTES), combined vaginal to laparoscopic surgery and mini laparoscopic percutaneous approaches according to the facilities of their centers and their skills or experiences. [6][7][8][9][10][11] In this study, two-port laparoscopic surgery (TPLS), which was performed in some cases of free benign adnexal pathologies through 5 and 10-mm ports through which conservative surgery was not performed, has been presented in the literature first according to our best of knowledge. These pathologies can be listed as tubal ectopic pregnancy, hydrosalpinx, ovarian serous cyst adenoma, dermoid cyst, ovarian torsion, and so on in our study.…”

“…Surgical options in terms of the management of a benign adnexal mass include ovarian cystectomy, salpingostomy or excisional procedure such as salpingo‐oophorectomy for indications of tubal ectopic pregnancies and ovarian cysts that need surgery 5 . Currently, surgeons dealing with minimally invasive surgery are able to choose between conventional multiport laparoscopic surgery (CMLS), laparoendoscopic single‐site (LESS) surgery, robotic LESS surgery, vaginal natural orifice transluminal endoscopic surgery (vNOTES), combined vaginal to laparoscopic surgery and mini laparoscopic percutaneous approaches according to the facilities of their centers and their skills or experiences 6–11 . In this study, two‐port laparoscopic surgery (TPLS), which was performed in some cases of free benign adnexal pathologies through 5 and 10‐mm ports through which conservative surgery was not performed, has been presented in the literature first according to our best of knowledge.…”