Vaginal transluminal endoscopic hysterectomy and adnexal surgery for benign gynaecological conditions

2.1 Benign gynaecological conditions refer to non-cancerous conditions affecting the female reproductive systems. These include, but are not limited to, chronic pelvic pain, uterine prolapse, fibroids and abnormal vaginal bleeding. Left untreated, these conditions can lead to severe and prolonged pain, infections, and reduced quality of life.

2.2 The current surgical treatments for this set of conditions includes hysterectomy, adnexectomy and myomectomy. Conventional hysterectomy (removal of the uterus) is done through a cut in the abdomen or through the vagina. There are also laparoscopic approaches.

2.3 An adnexectomy involves removing the ovaries or fallopian tubes. This can be done alongside a hysterectomy or on its own.

2.4 Myomectomies are keyhole or open surgeries which remove fibroids that develop around the womb.

2.5 The vaginal transluminal endoscopic hysterectomy procedure is done in a similar way to a conventional vaginal hysterectomy but uses an endoscopic view and laparoscopic instruments. The patient is placed in the lithotomy position. Under general anaesthesia, a circular incision is made in the vagina (around the cervix). Following anterior/posterior colpotomy and transecting the sacro-uterine ligaments, a keyhole instrument port with transvaginal indication is then inserted to improve access and visibility. The abdominal cavity is accessed through the colpotomy and then insufflated. Laparoscopic instruments are inserted and the surgery is done in a Trendelenburg (head down) position. Then the uterus, fallopian tubes or ovaries are removed vaginally (depending on the procedure type). Then the instrument port is removed, the abdomen is deflated, and the vaginal incision is closed with absorbable sutures.