2024 Volume 40 Issue 2 Pages 162-165
Hysterectomies by vaginal natural orifice transluminal endoscopic surgery (vNOTES) have advantages, including reduced pain and shorter hospital stays than conventional endoscopic hysterectomies. However, we often experience difficulties with vaginal surgery in patients with obesity. Herein, we show how to open the peritoneum easily using indigo carmine staining in a patient with obesity.
A 49-year-old female who had experienced three pregnancies and two deliveries (body mass index [BMI] 37) exhibited pallor suggestive of anemia during physical examination 4 years before surgery and was diagnosed with uterine adenomyosis. She was referred to our hospital for surgery due to recurrent menorrhagia after GnRH agonist treatment. Internal examination revealed uterine mobility, and magnetic resonance imaging (MRI) revealed anterior wall thickening up to 7 cm, suggesting adenomyosis. Due to obesity, her vNOTES hysterectomy was expected to be difficult. A fallopian tube spacing catheter was inserted into the uterine cavity, and 30 ml of indigo carmine solution diluted with saline was injected. A circular cervical incision was made, the bladder was detached from the cervix, and a transverse incision was made through the cysto-uterine and Douglas fossae's peritoneum, which were transparent blue. Total hysterectomy and bilateral salpingectomy were performed. Rare occurrences of bladder injury during vNOTES hysterectomies. Vaginal surgery is particularly difficult in patients with obesity. In this case, vNOTES hysterectomy was easily performed using indigo carmine staining in a patient with obesity. Consent was obtained from the patient to submit this report.
