Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive surgical technique that uses the natural orifices of the human body such as the vagina (vNOTES) in order to access the abdominal cavity. Currently, the vNOTES hysterectomy technique is carried out on benign indication such as dysfunctional blood loss, uterine myomatosis or adenomyosis. During surgery, the surgeon and the assistant are able to operate in a better ergonomic position than at a total laparoscopic or vaginal hysterectomy. In addition, they have a better view of the anatomical structures in the operative field and therefore fewer peroperative complications occur. The vNOTES hysterectomy procedure has been carried out at the Zuyderland Medical Centre, Heerlen, the Netherlands, since August 2019 to the satisfaction of both patients and surgeons.
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vNOTES as a salvage method for adnexectomy and high uterosacral ligament suspension after vaginal hysterectomy under epidural anesthesia: A feasibility and safety study.
Eur J Obstet Gynecol Reprod Biol
January 2025
Objective: To evaluate the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for performing adnexectomy and high uterosacral ligament suspension (HUSLS) after vaginal hysterectomy (VH) under epidural anesthesia.
Method: This was a retrospective case series of 42 women who underwent VH for stage II or greater apical prolapse according to pelvic organ prolapse quantification (POP-Q); however, adnexectomy could not performed and replace the vNOTES technique. The procedure continued with vNOTES adnexectomy and bilateral HUSLS under epidural anesthesia.
Gallbladder carcinoma in the era of artificial intelligence: Early diagnosis for better treatment.
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Department of Anatomy, Division of Human Biology, School of Medicine, IMU University, Kuala Lumpur 57000, Kuala Lumpur, Malaysia.
Gallbladder carcinoma (GBC) is the most common malignant tumor of biliary tract, with poor prognosis due to its aggressive nature and limited therapeutic options. Early detection of GBC is a major challenge, with most GBCs being detected accidentally during cholecystectomy procedures for gallbladder stones. This letter comments on the recent article by Deqing in the , which summarized the various current methods used in early diagnosis of GBC, including endoscopic ultrasound (EUS) examination of the gallbladder for high-risk GBC patients, and the use of EUS-guided elastography, contrast-enhanced EUS, trans-papillary biopsy, natural orifice transluminal endoscopic surgery, magnifying endoscopy, choledochoscopy, and confocal laser endomicroscopy when necessary for early diagnosis of GBC.
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