[A new way of performing hysterectomy: natural orifice transluminal endoscopic surgery]. / Nieuwe manier om baarmoeder te verwijderen.

Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive surgical technique that uses the natural orifices of the human body such as the vagina (vNOTES) in order to access the abdominal cavity. Currently, the vNOTES hysterectomy technique is carried out on benign indication such as dysfunctional blood loss, uterine myomatosis or adenomyosis. During surgery, the surgeon and the assistant are able to operate in a better ergonomic position than at a total laparoscopic or vaginal hysterectomy. In addition, they have a better view of the anatomical structures in the operative field and therefore fewer peroperative complications occur. The vNOTES hysterectomy procedure has been carried out at the Zuyderland Medical Centre, Heerlen, the Netherlands, since August 2019 to the satisfaction of both patients and surgeons.

Volume-related measurement error by three-dimensional ultrasound with a rotational multiplanar technique.

BACKGROUND: The goal of this study was to calculate the accuracy of three-dimensional volume measurements with the rotational multiplanar technique VOCAL (Volume Organ Computer-aided AnaLysis). METHODS: An ultrasound phantom with 13 objects (volume 10.2-40.5 cm(3)) was created. After data acquisition, the volumes of the objects were measured with the VOCAL technique. RESULTS: A linear mixed model analysis showed a significant linear (B = -0.008, 95% CI -0.014, -0.002, p = 0.005) and a significant quadratic trend (B = 0.0001, 95% CI 0.000004, 0.0002, p = 0.040). The absolute error increases significantly with the increasing volume of interest with 0.044 cm(3) for each cm(3) rise of the volume of interest. The actual volume increased from an initial value of 10 cm(3) to values of 20, 30 and 40 cm(3), resulting in a decrease in the mean estimated percentage error from 15.4 to 10.6%, 8.0% and 7.5%. CONCLUSION: The results of this study showed that volume measurements with three-dimensional ultrasound and the VOCAL software can be used for volume measurements in vivo. However, it is important to assess the measurement error and to consider these error values when interpreting the results in daily practice.