1) The abdominal wall cuts were made because this was the first time this procedure had been tried on a human, not because it was standard of care. Future procedures would presumably omit this backup.

2) Given that laparascopic surgery involves using a camera as well as instruments, I fail to see how the transvaginal approach would give a lesser viewing screen than the current standard of care. I admit on this point that it’s possible the angle of the instruments is sub-optimal compared with the traditional approach. None of the articles have been helpful in clarifying this, and I didn’t make it to SAGES this year, where I presume this was presented.

3) Puncturing the abdominal wall is painful no matter how small the cuts. And despite a sterile field, wound infection is frequent. I’d be interested in seeing long-term follow-up on infection rates of the uterine wall, etc, as well as antibiotic and painkiller prescription rates.

4) I was under the impression that natural-orifice-surgery (and transoral surgery in particular) was developed to prevent metastatic spread of cancer to the abdominal wall. If the transvaginal approach was used for cancer resection, I’d rather give up my uterus than my peritoneum.

But as a woman, I can understand Dr. Ren’s somewhat instinctive revulsion, and Sid Schwab’s comment on bacteria in these orifices.