Addressing Access and Visualization Limitations in VNOTES: Evaluation of a Novel Laparoscopic Vaginal Speculum in a Porcine Model.

BackgroundVaginal natural orifice transluminal endoscopic surgery (VNOTES) is a minimally invasive technique with significant clinical potential. However, its widespread adoption has been hindered by technical challenges, particularly in the establishment and stabilization of the surgical access platform. In conventional vaginal surgery, the operative field is often limited by a narrow operative field, poor visualization, and difficulty in standardized surgical training. To address these limitations, a novel laparoscopic vaginal speculum system was designed and developed to overcome the limitations of the existing technologies. We conducted animal trials were conducted to demonstrate its feasibility for VNOTES hysterectomy in a porcine model.MethodsThe laparoscopic vaginal speculum system is a flexible and simplified laparoscopic visualization system comprising a protective connecting sleeve, multichannel base, sealing ring, and control plate. This innovative device facilitates the establishment of the VNOTES surgical access platform via a laparoscopic-guided approach, effectively replacing traditional transvaginal surgery used during the initial phase of the procedure.ResultsVNOTES hysterectomy was successfully performed in four Bama pigs. The mean operative time was 81.75 ± 18.91 minutes, with an estimated blood loss of 10.75 ± 3.40 mL. No intraoperative complications were observed. The system demonstrated excellent flexibility and provided clear and stable surgical visualization.ConclusionsThe trial demonstrate that this system provides a simplified, stable, and visualizable approach for establishing VNOTES surgical access platform. It offers sufficient workspace for laparoscopic instruments and enhances procedural flexibility, potentially improving the safety and efficiency of VNOTES surgery.