Natural orifice transluminal endoscopic surgery: The transvaginal route moving forward from cholecystectomy

Figure 1 Sagital view of the female pelvis showing the shape and location of the vaginal fundus that delineate the floor of the Douglas pouch.

Figure 2 Draft of the deep pelvis and the Douglas pouch showing the free zone for transvaginal access to the peritoneal cavity.

Figure 3 Images corresponding to the transvaginal access to the pelvis with the patient located in full lateral position, used for the transvaginal splenectomy. A: Intraoperative view of the Douglas pouch with the patient placed in full lateratl decubitus; B and C: Insertion of the trocar trough the lateral fundus of the posterior vaginal vault; D: Introduction to the scope ascending to the left hypochondrium.