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Anatomical measurements to optimize instrumentation for transvaginal surgery

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Abstract

Background

Use of rigid instruments via transvaginal (TV) route has been proposed as a practical alternative to natural orifice translumenal endoscopic surgery (NOTES) using flexible devices. However, its safety has not been fully evaluated for each abdominal organ with different positional relationship to the vagina. The aim of this study is to obtain baseline anatomical data necessary for safer use of rigid TV instruments, by three-dimensional (3-D) radiologic measurements.

Patients and methods

A retrospective study was conducted on 51 consecutive female Japanese patients with aortic aneurysm who underwent whole-body multidetector computed tomography as preoperative evaluation. The gallbladder (GB), esophagogastric junction (EGJ), and spleen were located on 3-D images, and the following were obtained: (1) the distance from the vagina, (2) the transverse deviation from the midline, and (3) the sagittal deviation from the “vagina–promontory (V–P)” line.

Results

The median distance from the vagina was 26.1 cm for GB, 30.6 cm for EGJ, and 31.1 cm for spleen. The transverse deviation from the midline was 17.7° for GB, 7.0° for EGJ, and 12.9° for spleen. The sagittal deviation from the V–P line was 7.6 degrees for GB, −7.0° for EGJ, and −10.3° for spleen. The percentage of “negative angle” cases, which means that the target is located “below” the V–P line, was only 9.8 % for GB versus 88 % for EGJ and spleen.

Conclusions

The intra-abdominal length of TV instruments should be more than 35 cm in Japanese population. GB is widely deviated from the midline and therefore can be safely approached even with rigid/straight instruments. Access to more midline and distant targets may suffer from interference by the sacral promontory, and be potentially dangerous in terms of risk of compression injury by rigid and straight instruments.

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Acknowledgments

Part of this article was presented at the 20th International Congress of the European Association for Endoscopic Surgery (EAES), Brussels, Belgium, on 23 June 2012. The authors acknowledge Toru Kuratani, MD and Yoshiki Sawa, MD, Department of Cardiovascular Surgery, Osaka University, for providing the patient database used in this study. Funding from a Japan NOTES Research Grant 2009 is acknowledged.

Disclosures

Authors Nakajima, Souma, Takahashi, Yamasaki, Miyazaki, Mori, and Doki have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

    Kiyokazu Nakajima, Yoshihito Souma, Tsuyoshi Takahashi, Makoto Yamasaki, Yasuaki Miyazaki, Masaki Mori & Yuichiro Doki

  2. Division of Collaborative Research for Next Generation Endoscopic Intervention (Project ENGINE), The Center for Advanced Medical Engineering and Informatics, Osaka University, 2-2, M-2, Yamadaoka, Suita, Osaka, 565-0871, Japan

    Kiyokazu Nakajima

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  1. Kiyokazu Nakajima
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  2. Yoshihito Souma
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  3. Tsuyoshi Takahashi
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  4. Makoto Yamasaki
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  5. Yasuaki Miyazaki
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  6. Masaki Mori
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  7. Yuichiro Doki
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Correspondence to Kiyokazu Nakajima.

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Nakajima, K., Souma, Y., Takahashi, T. et al. Anatomical measurements to optimize instrumentation for transvaginal surgery. Surg Endosc 27, 2052–2057 (2013). https://doi.org/10.1007/s00464-012-2709-2

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  • DOI: https://doi.org/10.1007/s00464-012-2709-2

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