Objective

To describe and assess the feasibility of a novel surgical technique (pneumovaginoscopy) for performing vaginal surgery.

Design

Video of a single surgical procedure.

Setting

A university hospital.

Patient(s)

A 42-year-old woman, gravida 2 para 2, presented with chronic pelvic pain. Vaginal examination revealed a 4-cm spherical mass bulging through her posterior vaginal wall. Magnetic resonance imaging identified this mass as either a subserosal pedunculated uterine fibroid (type 7 according to the FIGO classification) or an ectopic fibroid of the posterior vaginal wall (type 8).

Intervention(s)

The whole procedure was performed using pneumovaginoscopy. The GelPOINT V-Path (Applied Medical, Rancho Santa Margarita, California) which is the device most often used to perform transvaginal natural orifice transluminal endoscopic surgical procedures, was introduced into the vagina to create a pneumovagina. Monopolar scissors were used to create an incision through the posterior vaginal wall to reach the fibroid. Myomectomy was performed using traction movements of the fibroid associated with the dissection of the capsule. The absence of a uterine pedicle at the end of the myomectomy was in favor of an ectopic fibroid of the vagina (type 8 of the FIGO classification). The vaginal defect was closed with interrupted sutures using the access points on the GelPOINT.

Main outcome measure(s)

The procedure was easily and efficiently performed using the pneumovaginoscopy technique and lasted less than an hour. The patient was discharged on postoperative day 1 without any postoperative complications. She was symptom-free at her 2-month postoperative visit.

Result(s)

Compared to the classical vaginal approach, pneumovaginoscopy improves visualization through targeted lighting and close-up vision. This technique is particularly interesting in cases where the vaginal opening is narrow and for lesions located in the upper half of the vagina. Because of the unusual expansion of the vagina, increased caution is required to avoid bladder or rectal injuries.

Conclusion(s)

Pneumovaginoscopy is a novel technique that can be performed for vaginal pathologies with the same device used for transvaginal natural orifice transluminal endoscopic surgery. We described this technique and assessed its feasibility.

中文翻译：

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使用 pneumovaginoscopy 执行去除阴道肌瘤

客观的

描述和评估用于进行阴道手术的新型手术技术（阴道阴道镜检查）的可行性。

设计

单个手术过程的视频。

环境

大学医院。

耐心）

一名 42 岁女性，妊娠 2 段 2，因慢性盆腔疼痛就诊。阴道检查发现一个 4 厘米的球形肿块从她的阴道后壁凸出。磁共振成像将此肿块识别为浆膜下带蒂子宫肌瘤（FIGO 分类的 7 型）或阴道后壁异位肌瘤（8 型）。

干预措施

整个过程使用阴道镜进行。GelPOINT V-Path（Applied Medical，Rancho Santa Margarita，California）是最常用于执行经阴道自然孔道经腔内窥镜外科手术的设备，它被引入阴道以形成 pneumovagina。使用单极剪刀通过阴道后壁切开到达肌瘤。子宫肌瘤切除术是使用与囊的解剖相关的肌瘤的牵引运动进行的。在子宫肌瘤切除术结束时没有子宫蒂有利于阴道异位肌瘤（FIGO 分类的 8 型）。使用 GelPOINT 上的接入点通过间断缝合关闭阴道缺损。

主要观察指标）

使用 pneumovaginoscopy 技术可以轻松有效地执行该过程，并且持续不到一个小时。患者术后第 1 天出院，无任何术后并发症。她在术后 2 个月就诊时无症状。

结果）

与经典的阴道方法相比，肺阴道镜通过有针对性的照明和特写视觉提高了可视化。在阴道口狭窄和位于阴道上半部的病变的情况下，这种技术特别有趣。由于阴道异常扩张，需要更加小心以避免膀胱或直肠损伤。

结论

Pneumovaginoscopy 是一种新技术，可以使用与经阴道自然孔道经腔内窥镜手术相同的设备对阴道病变进行检查。我们描述了这种技术并评估了它的可行性。