Evaluation of Vaginoscopy in Ewes Utilizing the Sils™ Port

Introduction
Laparoscopic single site surgery is a technique where laparoscopic surgery is performed exclusively through a single entry point. The SILSTM port (Covidien, Mansfield, MA) has been previously described in the veterinary literature. This malleable port can accommodate three 5 mm or two 5 mm cannulas and one 12 or 15 mm cannula along with a dedicated port for insufflation. Our purpose was to evaluate the technical feasibility and reproducibility of transvaginal access and vaginoscopy using the SILS™ port device within ewes. We hypothesized that the SILSTM port would be a simple and safe alternative to traditional vaginoscopy approaches and provide appropriate visualization of vaginal structures, aiding in vaginal procedures such as biopsies.

Materials and methods
Eight healthy, mature ewes (four to eight years old; n=8) were used in this study. Animals were placed under general anesthesia in dorsal recumbency. The vulvar region was clipped and prepared prior to vaginoscopy. The pliable SILSTM port was manipulated through the vulva using a hemostat until securely in place extending from the vulva to the vaginal fornix. Three cannulas, two 5 mm (instrument cannula) and one 12 mm cannula (endoscope and camera), were inserted through the holes of the SILSTM port (Figure). Carbon dioxide insufflation was maintained at approximately 9 mm Hg. The vaginal vault was explored and vaginal biopsies were performed. Digital video and still images were recorded in each animal.

Results
Placement of the SILSTM port was technically easy to achieve. The SILSTM port provided consistent visualization of the entire vaginal vault, including the cervix, in all eight ewes. The SILSTM port provided an effective seal to allow insufflation of the vaginal vault, which was required for complete visualization. The two 5 mm instrument cannulas were successfully utilized for mucosal biopsies in all eight ewes. Varying the insufflation pressures aided in the manipulation of vaginal tissues. No adverse events occurred following vaginoscopy using the SILSTM port in all ewes.

Discussion
This report demonstrates that the SILSTM port is a feasible, safe, simple and intuitive technique for performing vaginoscopy in ewes. The use of the SILSTM port provides a tight seal for insufflation, which is vital for consistent visualization of the entire vaginal vault. It also allows for the passage of two instruments into the vaginal vault for diagnostic or therapeutic procedures. While a rigid endoscope was utilized in this study, the SILSTM port can accommodate a flexible endoscope of equivalent diameter. Quality video and still images can be easily obtained using this technique for teaching or client education purposes. Further evaluation of the SILSTM port is warranted in other animals as a feasible vaginoscopy technique.