"Single Port/Pneumovagina Technique" for two further applications

Abstract Study Objective To demonstrate a novel technique to surgically treat certain vaginal conditions. Design Technical video demonstrating two cases in which the technique is used Setting The Gynecological Minimally Invasive and Robotic Surgery Unit at Clinica Universitaria (private clinic), Concepcion, Chile. Patients Case 1: 35-year-old woman with a bicornuate unicollis uterus presented with dyspareunia. Her examination revealed an incomplete longitudinal vaginal septum. Her right hemivagina was slightly wider than the left one. Under spinal anesthesia we performed a complete resection of the septum using the "Single Port/Pneumovagina Technique" (SPPT). Case 2: 36-year-old nulligravida who complained of dyspareunia. On clinical exam she had a 3 cm leiomyoma in the proximal vaginal third. Doppler powered pelvic ultrasound ruled out any vascular communication with the cervix. We performed a vaginal myomectomy using the SPPT under spinal anesthesia. In this particular case we used a fourth trocar in the gel cap to use a myoma screw. Interventions In this technique we create a Pneumovagina occluding the introitus with the aid of a single port device (GelPoint Path; Applied Medical, Rancho Santa Margarita, CA). We selected this particular device, designed for transanal surgery, because it´s access channel avoids gas leakage after applying gentle pressure on the cap. The working cannel is 4 × 4,5 cm and up to 4 trocars can be inserted in the gel cap. We use 12 mmHg of pressure to create the pneumovagina and 5 l/min flow to maintain it. Similar approaches had been recently described for treating eroded and/or infected sacrocolpopexy mesh. [1] , [2] , [3] . One could question the utility of this approach over conventional vaginal surgery, and in this sense we believe it provides both, surgeon and surgical assistant, a much more comfortable and ergonomic position while performing surgery. It also improves the view of anatomical structures for all the surgical team, which in conventional vaginal surgery is limited only to the surgeon. Measurements and main results Both procedures were uneventful. Operation time in Case 1 was 5 minutes and the patient was discharged 4 hours later. Case 2 lasted 35 minutes and was discharged 12 hours later. Conclusion The creation of a Pneumovagina with the application of a Single port device provides an excellent view of vaginal structures and allows the application of laparoscopic techniques to perform vaginal surgeries in a much more ergonomical fashion compared to conventional vaginal surgery.