Usefulness of transvaginal natural orifice transluminal endoscopic surgery in a post-liver transplantation patient with suspected severe intra-abdominal adhesion

Abstract

We present a case of a 52-year-old patient with persistent cervical intraepithelial neoplasm I (CIN I) positive for HPV type 16. Since the patient was taking immunosuppressants after liver transplantation, exacerbation of CIN was suspected. A total hysterectomy was planned; however, first puncture using umbilicus was considered difficult because of severe adhesion of upper abdominal wall due to liver transplantation. Therefore, a total hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES), which is an approach from the vagina, was planned. Although the vaginal wall was narrow due to nulliparous, it was confirmed that there were no adhesions within the pelvis. A hysterectomy with vNOTES was performed. In laparoscopic surgery, if intraperitoneal adhesions are suspected, organ damage upon the first puncture is a problem, but vNOTES reached the abdominal cavity safely. vNOTES was considered useful and safe for hysterectomy in a patient with suspected severe intra-abdominal adhesion.