A Novel Approach to Combined Vaginal and Laparoscopic Gynecological Surgery

Background and objectives: In this case series, we propose a novel approach to combined vaginal and laparoscopic surgery in which a posterior colpotomy and 2 5-mm abdominal incisions are used to perform benign gynecological procedures. We seek to assess the safety and feasibility of this technique in difficult surgical candidates such as those with obesity or prior laparotomies, as well as to detail intra- and postoperative complications associated with the procedure.

Methods: We collected demographic, clinical, intra-operative, and postoperative data on 45 women who underwent a combined vaginal and laparoscopic gynecological surgery for benign indications by a single surgeon between February 2013 and August 2017.

Results: From February 2013 through August 2017, 45 women underwent a combined vaginal and laparoscopic surgery at 2 institutions. Procedures included adnexal surgery (n = 32, 71%), and total hysterectomy (n = 13, 29%). Of patients who underwent adnexal surgery, two had minor postoperative complications. No patients had major complications. In addition, no patients had postoperative vaginal infections or pelvic abscesses, and there were no readmissions within 30 days after the procedures.

Conclusion: Our proposed combined vaginal and laparoscopic approach to benign gynecological surgery can be utilized in difficult surgical candidates including those with obesity, nulliparous patients, and those with prior abdominal surgery. Our data has shown that this approach is safe and effective.