Stephanie G Wood, MD, Lucian Panait, MD, Robert L Bell, MD, Andrew J Duffy, MD, Kurt E Roberts, MD. Yale School of Medicine
Natural Orifice Transluminal Endoscopic Surgery (NOTES) has been at the forefront of minimally invasive surgery. Benefits include no visible scars, less pain and shorter recovery. We present a video of a 38 years old female with a BMI 36.4 kg/m2 who underwent a pure transvaginal umbilical hernia repair. This is one out of 2 successfully performed pure transvaginal ventral hernia repairs at Yale-New Haven Hospital. Appropriate Institutional Review Board was obtained preoperatively.
The patient was positioned in steep Trendelenberg position at which time a weighted speculum was introduced into the vagina allowing exposure of the posterior vaginal fornix. The cervix was grasped with a single-toothed tenaculum on the posterior cervical lip and the posterior vaginal fornix visualized. Access to the peritoneum was achieved by electrocautery and then sharp dissection. Then a SILS port was introduced and pneumoperitoneum up to 15mmHg was achieved. Two 5mm trocars and one 12mm trocar were used. The 2cm umbilical hernia was then visualized, and the contained omentum was removed sharply and bluntly. A 12 cm Parietex™ mesh was introduced through the 12mm port and opened in peritoneal cavity. The mesh was approximated with hernia defect centered. A stitch was placed to abdominal fascia superiorly and an AbsorbaTack™ fixation device was used to tack the mesh to abdominal wall circumferentially using a double crown technique. The pneumoperitoneum was released and port was removed. The vagotomy incision was closed with a running Polysorb sutures. The patient was extubated, transferred to the recovery room and subsequently discharged home without any complications.
We have successfully demonstrated the feasibility and safety of a pure transvaginal umbilical hernia repair without any abdominal incisions whatsoever. This video presents one of these 2 procedures. It is safe and well tolerated with only minimal need for postoperative pain control. It allows for rapid return to daily activities while providing a most favorable cosmetic outcome for women. More extensive studies evaluating the benefits and also identifying possible complications are necessary to confirm our promising early results.
Session Number: SS25 – Videos: NOTES / Flexible Endoscopy
Program Number: V070