Iodine-Negative Vaginal Cuff Zones: Endoscopic Mapping of Structural Vulnerability NBI and Lugol's Iodine for Functional and Topographical Assessment Post-Laparoscopic Hysterectomy

AbstractPersistent vaginal vault lesions after Total Laparoscopic Hysterectomy (TLH) present a diagnostic challenge. We report a case 18 months post-TLH for adenomyosis, presenting with a friable vault mass and concurrent enterocele. Evaluation using White Light Endoscopy (WLE), Narrow Band Imaging (NBI), and Lugol’s Iodine (VILI) enabled precise tissue characterization. NBI (blue and green light) identified organized, benign vascular loops, effectively excluding malignancy, while VILI demarcated iodine-negative zones functioning as topographical markers for immature epithelial “weak points” overlying the enterocele. This study emphasizes the clinical utility of multimodal endoscopic assessment for mapping the vaginal cuff and identifying structural vulnerabilities.