Pure NOTES: Transvaginal Tubal Sterilization with Flexible Endoscope

Jose Mejias, MD, Hector Almau, MD, Pierina Rosales, MD, Rafael De la Fuente, MD, Carlos Bravo, MD. Clinica Dr. A.L. Briceño Rossi

Tubal sterilization is a permanent contraception, done through different approaches, including: laparotomy, mini-laparotomy, colpotomy, laparoscopy and hysteroscopy (Essure®). Today describes two new approaches: LESS and transgastric or transvaginal NOTES. We report the surgical technique for pure NOTES transvaginal sterilization. Patient 32 years old, IIG, I P IC, BMI 20 Kg/mt2.

Surgical steps: 1- Trendelenburg patient positioning, vaginal washing with povidone iodine solution, urinary catheter placement. 2- 5 mm umbilical trocars placement for pneumoperitoneum and optical control of the vaginal approach. 3. Posterior colpotomy 2 cm length, introduction of a single channel, Olympus gastroscope, placement of uterine manipulator. 4. Peritoneoscopy, positioning of the endoscope in retroflexion identifying the Fallopian tubes; 3 QuickClip (Olympus HX 610 135) are applied in each tube, followed by tube coagulation with coagrasper (FD-410LR Olympus). 5. Colpotomy closure is performed with absorbable, continuous suture. Results: Operating time 25 minutes. Patient discharged 6 hours after the procedure. Analog pain scale, with scores from 0 to 10, 24 hours and seven days after the procedure remained in 0, with no need of postoperative pain management. Gynecological examination was performed 45 days after with no pathological findings. An hysterosalpingography demostrated on-site placement of clips in both tubes with no leaks of contrast and complete occlusion of both tubes.

Conclusion: transvaginal flexible endoscope approach with clipping of the Fallopian tubes is a new surgical techniques for permanent sterilization that can be performed safely, significantly reducing postoperative pain, with fast recovery and effective cosmesis.