{"paper_id":"062d841c-c68e-4ecb-8b88-e6e41032c2a1","body_text":"Abstract\nGynecologic surgeons use different methods for entering the abdomen during surgical procedures. In most cases, the abdominal route is preferred, as surgeons are more comfortable with this approach due to their training in performing laparotomies or laparoscopic procedures. Previous surgeries, defects in the abdominal wall (such as vessels, hernias, and adhesions), and foreign bodies (like mesh and other implants) can distort the anatomy and increase the risk of intra-abdominal injury during surgery. Prior abdominal surgeries are traditionally considered risk factors for developing abdominal adhesions, which can make abdominal entry more challenging. Transvaginal access offers surgeons a potentially adhesion-free area, avoiding the need for abdominal incisions and potentially improving cosmetic outcomes and reducing pain.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nNulens K, Kempenaers R, Baekelandt J. Hysterectomy via vaginal natural orifice transluminal endoscopic surgery in virgin patients: a first feasibility study. J Obstet Gynaecol. 2022;42(1):116–21. https://doi.org/10.1080/01443615.2020.1867972.\nNaval S. vNOTES lateral window approach to hysterectomy in a case with previous history of multiple surgeries resulting in keloid scars and enlarged uterus with dense bladder adhesions. J Minim Invasive Gynecol. 2022;29(2):193. https://doi.org/10.1016/j.jmig.2021.08.020.\nPascoal E, Wessels JM, Aas-Eng MK, Abrao MS, Condous G, Jurkovic D, et al. 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BMC Surg. 2020;20(1):234. https://doi.org/10.1186/s12893-020-00897-3.\nAuthor information\nAuthors and Affiliations\nEditor information\nEditors and Affiliations\n4.1 Electronic Supplementary Material(s)\nPositive sliding sign—free cul-de-sac (MP4 15,577 kb)\nNegative siding sign—complete cul-de-sac obliteration (MP4 14,916 kb)\nNegative sliding sign and triangle sign—complete obliteration of the cul-de-sac (MP4 14,978 kb)\nPositive sliding sign and triangle sign—normal cul-de-sac (MP4 14,917 kb)\nRights and permissions\nCopyright information\n© 2025 The Author(s), under exclusive license to Springer Nature Switzerland AG\nAbout this chapter\nCite this chapter\nDueñas Garcia, O.F., Leonardi, M., Shishkina, A. (2025). Identifying the Right Candidates for vNOTES. In: Dueñas Garcia, O.F., Baekelandt, J.F., May, G. (eds) Atlas of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES). Springer, Cham. https://doi.org/10.1007/978-3-031-83713-5_4\nDownload citation\nDOI: https://doi.org/10.1007/978-3-031-83713-5_4\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-031-83712-8\nOnline ISBN: 978-3-031-83713-5\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}