We propose a phase I study of laparoscopic assisted, transvaginal peritoneoscopy by using
flexible endoscopy in female patients with pelvic pain. It is designed as a hybrid procedure
with laparoscopy using one port for adequate safety with the ultimate goal in the future
that transvaginal NOTES can replace therapeutic pelviscopy for this indication. The standard
number of port sites for diagnostic laparoscopy is 2-3. By reducing the number and size of
laparoscopic port, patients should already experience benefits from this hybrid procedure.
Approximately 50% of patients with chronic pelvic pain will have a normal laparoscopy. The
vast majority of women with endometriosis, chronic pelvic pain and absence of ovarian
endometriomata determined by ultrasound will have revised ASRM Stage I or II (peritoneal)
disease with preservation of the posterior cul-de-sac. This sparing of the posterior
cul-de-sac may offer a preferable route of entry for endoscopic surgery compared to the
current standard of care.
Despite all the advantages of laparoscopic surgery, it is not free of risks and pain, and
creates scars, which themselves are associated with complications such as abdominal wall
hernias and adhesions.
Within this scenario, a new surgical procedure has emerged, called natural orifice
transluminal endoscopic surgery (NOTES). This technique uses existing orifices of the body
for introducing optical systems and surgical instruments into the peritoneal cavity by
avoiding penetration of the abdominal wall. The expectations are no postoperative pain,
optimal cosmesis without any visable scars and shorter recovery similar to therapeutic
- Women age 18 and older who have an indication and scheduled for laparoscopic
- Known pelvic adhesive disease or greater than stage II endometriosis or sonographic
evidence of endometrioma.
- BMI over 30.
- Major comorbidities - including diabetes, myocardial infarction, congestive heart
failure, stroke, history of cancer or currently undergoing chemotherapy, autoimmune
disease requiring immunosuppressive or steroid therapy .
- Any primary bowel disease (IBD, sprue, obstruction, acute appendicitis, gastric
- Any known PID, tuboovarian mass or abscess, or active sexually transmitted infection.
- Retroflexed uterus