PMC4258338_01
Transvaginal 12 mm trocar and a separate 5 mm grasper (without trocar) placement under laparoscopic guidance. View of posterior fornix.
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fig1
A 12 mm trocar and a 5 mm grasper without a trocar were inserted separately through the posterior fornix of the vagina under laparoscopic guidance (Figure 1).
Transumbilical 5 mm, 30  laparoscope and perineal view.
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fig2
The reason for the transvaginal grasper insertion without trocar was the proximity of the surgical instruments at the perineum (Figure 2).
Division of mesoappendix through the umbilical port by Ligasure (5 mm).
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fig3
After moving the camera to the vaginal trocar, the distal end of the appendix was held with the vaginal grasper and the mesoappendix was divided by Ligasure (ForceTriad, Covidien, Boulder, CO, USA) through the umbilical trocar (Figure 3).
Postoperative appearance of the abdomen.
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At the one-month ambulatory follow-up, the abdominal and vaginal wounds had healed well, and the patient had no complaints (Figure 4).