Introduction/Background The objective of this video is to demonstrate a surgical technique for vNOTES staging surgery of borderline ovarian cancer.

Methodology This is a Stepwise demonstration of vNOTES for hysterectomy, infracolic omentectomy and appendicectomy with narrated video footage. The diameter of Alexis is 10 cm, and we used the GelPOINT V-Path transvaginal access platform (Applied Medical).

We used a 30-degree lens, a sealing device and gripping clamp.

It is a case of 59 years old patient with the diagnosis of complex adnexal mass. We performed bilateral salpingoophorectomy by conventional laparoscopy. The anatomopathologic exam was mucinous borderline ovarian cancer.

First, the hysterectomy begins in the same way as vaginal hysterectomy, a circumferential incision is made and the anterior and posterior colpotomy is performed, and the vesicovaginal and rectovaginal space is approached, followed by sealing and cutting of the upper parametrium. The vNOTES port is then place, first insert the Alexis Retractor anteriorly and then, posteriorly. Deploy Alexis Ratractor, attach Gelseal Cap, and stablish the pneumoperitoneum.

Starting on the patient’s left side, the cervix is pushed medially and cephalad to expose the uterine vessels, which are transected with sealing device, followed by the transection of round and uterosacral ligaments. Then, we cut the adhesions of omentum to the anterior abdominal wall to perform the infracolic omentectomy and finally, the appendix is identified, its meso is dissected, sealed, and cut.

Results The operation time was 115 minutes, there were no intra and postoperative complications, and the hospital stay was 1 day. Pain scale EVA: 3.

Conclusion Staging surgery of borderline ovarian cancer by vNOTES approach is a feasible technique that appears to be safe and reproducible. The advantages of VNOTES are less pain, improved cosmesis, decreased risks relayed to abdominal entry and port placement, such as visceral and abdominal wall injuries, port sites hernias, and nerve entrapments.

Disclosures No disclosures.