vNOTES uses the vagina as the surgical channel for endoscopy and achieves improved cosmesis compared to conventional laparoscopy as there are no abdominal incisions. Ventrofixation of the uterus to the abdominal wall following previous cesarean sections further adds to the surgeon's concern of bladder injury. In such cases, a modification of the technique is proposed: introducing the vNOTES port first, before the opening of the vesico-uterine peritoneal folds, thus carried out under endoscopic view. Medial anterior vesico-uterine adhesions are identified and circumscribed by creating a lateral window in the broad ligament on both sides. This allows the cutting of adhesions under endoscopic view to minimize the risk of bladder injuries. The aim of this technical note is to present this modification of the surgical technique for vNOTES hysterectomy in case of ventrofixed uterus.

vNOTES使用阴道作为内窥镜检查的手术通道，与传统腹腔镜检查相比，由于没有腹部切口，因此改善了美容效果。先前剖腹产后子宫腹壁固定进一步增加了外科医生对膀胱损伤的担忧。在这种情况下，建议对该技术进行修改：首先在打开膀胱子宫腹膜皱襞之前引入 vNOTES 端口，从而在内窥镜视图下进行。通过在两侧阔韧带中创建侧向窗口来识别和限制内侧前部膀胱子宫粘连。这样可以在内窥镜下切割粘连，从而最大限度地减少膀胱损伤的风险。本技术说明的目的是介绍针对腹腔固定子宫的 vNOTES 子宫切除术手术技术的这种改进。