OBJECTIVE To describe our simplified two-step technique for transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and to demonstrate the application of the technique. DESIGN Step-by-step description of the technique and demonstration of its application using surgical video footage from two different cases. SETTING Tertiary university hospital. PATIENT(S) Patient 1 was a 27-year-old G0P0 woman who presented with right lower quadrant pain. Transvaginal ultrasound scan revealed a right ovarian torsion. Patient 2 was a 25-year-old G3P2 woman. She presented with vaginal bleeding and left lower quadrant pain. Her serum β-human chorionic gonadotropin level was 28,313 U/L, and transvaginal ultrasound scan revealed an ectopic pregnancy in the left tube. The decision to perform vNOTES was made for both patients. INTERVENTION(S) As the first step, patients underwent diagnostic vNOTES. The patient was placed in lithotomy position under general anesthesia. By use of a 5-mm trocar with autoretracting blade, a colpotomy was performed on the posterior vaginal wall. Pneumoperitoneum was achieved, and the patient was placed in a Trendelenburg position. A 5-mm 30° rigid endoscope was introduced, and the diagnosis was confirmed. After the confirmation of the diagnosis, we proceeded to the second step. The colpotomy was enlarged with blunt dissection by using Metzenbaum scissors. A self-constructed pessary port was placed through the colpotomy, and pneumoperitoneum was achieved. The therapeutic procedure was then performed. Patient 1 underwent ovarian detorsion with a 5-mm laparoscopic grasper. After the ovary was detorsioned, a 5-mm bipolar instrument was used to achieve hemostasis. Patient 2 underwent left salpingectomy with a 5-mm advanced bipolar device. Hemostasis was verified, and the specimen was extracted through the colpotomy. Procedures ended with the closure of colpotomy with running resorbable sutures. MAIN OUTCOME MEASURE(S) Description of the technique and demonstration of its applicability in two common gynecological emergencies. RESULT(S) Both patients were treated successfully by vNOTES. The operating times were 25 minutes and 38 minutes for patient 1 and patient 2, respectively. Patients were discharged on postoperative day 1 without any complications. CONCLUSION(S) Our simplified two-step technique described and demonstrated in this video article is a feasible and practical approach to perform vNOTES. The first step allows the confirmation of the diagnosis and facilitates the colpotomy. The use of the self-constructed pessary port enables to perform surgery with already existing equipment without the need for specialized equipment and without increasing the costs.

中文翻译：

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经阴道自然孔道腔内镜手术的简化两步法

目的 描述我们用于经阴道自然孔道腔内镜手术 (vNOTES) 的简化两步技术并演示该技术的应用。设计 使用来自两个不同案例的手术视频片段逐步描述该技术并演示其应用。设置第三大学医院。患者 患者 1 是一名 27 岁的 G0P0 女性，出现右下腹疼痛。经阴道超声扫描显示右侧卵巢扭转。患者 2 是一名 25 岁的 G3P2 女性。她出现阴道流血和左下腹疼痛。她的血清 β-人绒毛膜促性腺激素水平为 28,313 U/L，经阴道超声扫描显示左输卵管异位妊娠。为两名患者做出了执行 vNOTES 的决定。干预 作为第一步，患者接受了诊断性 vNOTES。在全身麻醉下将患者置于截石位。通过使用带有自动回缩刀片的 5 毫米套管针，在阴道后壁上进行阴道切开术。实现了气腹，并将患者置于特伦德伦伯卧位。引入5mm 30°硬性内窥镜，确诊。确认诊断后，我们进行第二步。使用 Metzenbaum 剪刀钝性解剖扩大阴道切开术。通过阴道切开术放置自建子宫托孔，实现气腹。然后进行治疗程序。患者 1 使用 5 毫米腹腔镜抓取器进行了卵巢扭转。卵巢扭曲后，使用 5 毫米双极器械实现止血。患者 2 使用 5 毫米先进的双极装置接受了左侧输卵管切除术。证实止血，并通过阴道切开术提取标本。手术以使用可吸收缝合线关闭阴道切开术而告终。主要结局指标 描述该技术并证明其在两种常见妇科急症中的适用性。结果 两名患者均通过 vNOTES 成功治疗。患者 1 和患者 2 的手术时间分别为 25 分钟和 38 分钟。患者术后第 1 天出院，无任何并发症。结论（S）我们在本视频文章中描述和演示的简化的两步技术是执行 vNOTES 的可行且实用的方法。第一步允许确认诊断并促进阴道切开术。使用自建子宫托端口可以使用现有设备进行手术，无需专用设备，也不会增加成本。