Objective This video demonstrates a novel surgical technique for excision of an invasive vaginal lesion using a single port laparoscopic access device.

Study Methods A 31 year old female with a history of SLE on azathioprine presented with recurrent HSIL of cervix. A LEEP showed microinvasion measuring 2 mm and a vaginal fornix biopsy showed HSIL, but was clinically suspicious for invasion. The patient underwent a transvaginal endoscopic resection (TVER) of the lesion for diagnostic purposes. A single port laparoscopic access device was used for colpo-pneumo-occlusion. The endoscope was inserted into the vagina, and the 1.5 cm lesion was resected with margins of 5 mm under direct visualization using monopolar cautery. The mucosa edges were reapproximated with V-lock suture.

Results Pathology showed squamous mucosa with high-grade vaginal intraepithelial neoplasia and a focal area of invasion (with depth of invasion <1 mm). The patient tolerated the procedure well and was discharged from Day Surgery without any postoperative complications.

Conslusion Transvaginal endoscopic resection for superficially invasive vaginal lesions can be performed safely and provide accurate diagnosis with excellent visualization.