Successful Vaginal Natural Orifice Transluminal Endoscopic Surgery for Hysterectomy and Bilateral Salpingo‐Oophorectomy for Multilabel Large Fibroid Uterus: A Case Report
Wael Saad Elbanna, Osama Azmy, Mostafa Elabd, Ahmed Sherif Abdel HamidABSTRACT
Objective
To describe the successful use of vaginal natural orifice transluminal endoscopic surgery (vNOTES) for hysterectomy with bilateral salpingo‐oophorectomy in a patient with a large symptomatic fibroid uterus.
Methods
A 51‐year‐old nulligravida presented with chronic heavy menstrual bleeding and pelvic discomfort. Imaging demonstrated multiple uterine fibroids, including a large anterior intramural fibroid causing marked distortion of the endometrial cavity. After counselling regarding treatment options, including ovarian preservation versus removal and the implications of surgical menopause, the patient elected to undergo vNOTES hysterectomy with bilateral salpingo‐oophorectomy because of its minimally invasive, scarless approach and expected reduction in postoperative pain.
Results
The procedure was completed successfully without intraoperative or postoperative complications. Despite the large uterine size, complete removal of the uterus and adnexa was achieved, with a total specimen weight of 1800 g. Operative time was 160 min, and estimated blood loss was 220 mL. The patient was discharged within 24 h, remained pain‐free postoperatively, and was started on oral estrogen therapy.
Conclusion
This case demonstrates that vNOTES hysterectomy with bilateral salpingo‐oophorectomy can be a feasible and safe approach for selected patients with large benign uterine pathology. Even in the setting of a markedly enlarged fibroid uterus, the technique may offer effective surgical management, rapid recovery, minimal postoperative pain and improved cosmetic outcomes.