vNOTES Assisted Vaginal Bilateral Salpingo-Oophorectomy in Postmenopausal Women With Large Ovarian Fibroma.

The authors describe two cases where women with large ovarian fibromas (6 and 9 cm, respectively) underwent a transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) assisted bilateral salpingo-oophorectomy. Retrieval was facilitated by transvaginal cold knife morcellation in the Pouch of Douglas under direct vision following vNOTES assistance without abdominal incisions. This is the first time vNOTES has been described for excision of solid ovarian tumors of these dimensions; the authors discuss its advantages compared to conventional laparoscopy, together with challenges of retrieving a solid lesion through a posterior colpotomy incision.