vNOTES Surgical Management of a Tubal Ectopic Pregnancy

INTRODUCTION: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging surgical approach to gynecologic surgery, most often used for hysterectomy, that is becoming more widely used for adnexal surgery. It is an approach that uses a gel-port and laparoscopic instruments through the vagina, which facilitates a more complete view of pelvic anatomy and eliminates abdominal incisions. A common adnexal surgery performed by gynecologists is a salpingectomy for treatment of ectopic pregnancy. vNOTES has growing evidence that it is a safe and effective surgical approach for gynecologic emergencies, including ectopic pregnancy. OBJECTIVE: The aim of this surgical video is to expand the knowledge base and education available for vNOTES approach to gynecologic emergencies, specifically salpingectomy and treatment of ectopic pregnancy. METHODS: This surgical video contains footage from a single case where vNOTES was used to perform a unilateral salpingectomy for treatment of a tubal ectopic pregnancy. It also covers the abdominal entry and setup of the vNOTES gel-port for optimal surgical ergonomics and visualization of the operative field. RESULTS: This patient had an uncomplicated right tubal ectopic pregnancy identified and salpingectomy performed with operative time comparable to a laparoscopic approach. vNOTES approach was successful in facilitating complete survey of the abdomen, inspection of bilateral adnexa, identification of the ureters, and dissection necessary to complete the salpingectomy. CONCLUSIONS: This surgical video is an important addition to the body of educational materials available for vNOTES for gynecologic emergencies.