Available online 7 March 2024

To show feasibility and technique used to perform a total hysterectomy, bilateral salpingectomy, endometriosis resection, and ovarian reconstruction in a patient with a frozen pelvis secondary to a history of ruptured tubo-ovarian abscess.

Narrated step-by-step video demonstration.

Single academic institution

In patients with a history of multiple abdominal surgeries, abdominal mesh, or in the case of this patient, a history of ruptured tubo-ovarian abscess, a vaginal approach may offer a safer approach. Immediate access to the uterine pedicles through the vagina bypasses the need for extensive enterolysis and adhesiolysis through the abdomen. With the use of indocyanine green injected into bilateral ureters we show the benefits of immediate identification allowing for safer and more efficient dissection. We highlight rotational uterine maneuvers to aid in rectosigmoid to posterior-uterus dissection in limited space due to dense pelvic adhesions. Lastly, we underline the importance of ovarian reconstruction and oophoropexy in any ovarian surgery to allow for easier ovarian identification in future surgeries to possibly reduce the risks of ovarian remnant syndrome.

This video highlights the feasibility and strategies used to perform robot assisted vaginal natural orifice transluminal endoscopic surgery on a patient with a frozen pelvis.

The authors declare that they have no conflicts of interest and nothing to disclose.

IRB approval was not needed due to institutional policy.

Video Legend: 6 minute 30 second video case report detailing surgical approach to vNOTES surgery to perform a total hysterectomy, bilateral salpingectomy in a patient with a frozen pelvis, with recommendation to perform ovarian reconstruction and oophoropexy to reduce risk of ovarian remnant syndrome.

© 2024 Published by Elsevier Inc. on behalf of AAGL.