The vaginal route for minimally invasive surgery: a practical guide for general surgeons

Abstract

Introduction

Vaginal approaches have become routine in the field of gynecologic surgery, whereas in general surgery vaginal wall transection is an infrequent practice typically reserved for extensive tumor resections. Approximately two decades ago, natural orifice transluminal endoscopic surgery (NOTES) revolutionized conventional boundaries by accessing the peritoneal cavity transorally, transrectally, or transvaginally, enabling general surgery without visible scars. Although transvaginal approaches have been successfully used for various abdominal procedures by general surgeons, a gap remains in comprehensive training to fully exploit the potential of this route.

Material and methods

PubMed, Google Scholar, and Scopus databases were searched to retrieve relevant articles illustrating how general surgeons can adeptly manage vaginal approaches.

Results

The article presents a practical framework for general surgeons to execute a complete vaginal approach, addressing the management of vaginal specimen extraction and vaginal cuff closure, even in the absence of an experienced gynecologist.

Conclusion

The evolution of abdominal surgery is moving towards less invasive techniques, emphasizing the importance of understanding the nuances and challenges associated with the vaginal route. This approach is linked to minimal oncological, sexual, and infective complications, and to the absence of pregnancy-related complications. Such knowledge becomes increasingly crucial, particularly with the renewed demand for transvaginal access in robot-assisted NOTES procedures.

Keywords:

• Abdominal surgery
• general surgery
• minimally invasive surgery
• minimally invasive procedures
• NOTES
• single access laparoscopic surgery

Acknowledgments

The authors are grateful to Catherine Cers for illustrating the surgical procedures and to Guy Temporal for revising the English language.

Authors’ contributions

Dr. Matteo Pavone, Dr. Riccardo Oliva, and Prof. Antonello Forgione contributed to the study design. Dr. Matteo Pavone performed the literature research. Dr. Matteo Pavone, Prof. Barbara Seeliger, and Prof. Antonello Forgione drafted the manuscript. Dr. Lise Lecointre, Prof. Giovanni Scambia, Prof. Cherif Akladios, Prof. Denis Querleu, Prof. Jacques Marescaux, and Prof. Antonello Forgione are responsible for the critical revision of the manuscript and for major intellectual content. All authors have read and commented upon the working versions and approved the final manuscript prior to submission.

Declaration of interest

No potential conflict of interest was reported by the author(s).

Data availability statement

All data generated or analyzed in this review are included in this article and/or its figures. Further enquiries can be directed to the corresponding author.

Additional information

Funding

This work was supported by French state funds managed within the ‘Plan Investissements d’Avenir’ and by the ANR (reference ANR-10-IAHU-02).