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We refer to this technique as vaginally assisted NOTES hysterectomy (VANH) as the first part of this procedure is performed by conventional vaginal surgery. Once the anterior and posterior peritoneum were opened, both sacro-uterine ligaments were coagulated using the bipolar forceps and subsequently transsected using the cold scissors. Construction of the NOTES port: GelPOINT advanced access platform, with a 10 mm reusable trocar for CO2 insufflation and laparoscope insertion. Two 5 mm reusable trocars were placed for insertion of the reusable laparoscopic instruments.
Parametrium, the uterine arteries and the ovarian ligament, and Fallopian tube were coagulated using the bipolar forceps and subsequently transsected using the Caiman (Aescupal® Caiman® Advanced Bipolar Technology), after identification of both ureters. Mesosalpinx is bilatally coagulated and transsected using the Caiman®: bilateral salpingectomy. Total hysterectomy. Vaginal extraction of the uterus. Extraction of the GelPOINT advanced access platform. Closure of the vaginal vault with vaginally detached stitches.