Emergency transvaginal hybrid natural orifice transluminal endoscopic surgery

Abstract

In a clinical series, 10 consecutive female patients with intra-abdominal infections were successfully treated with natural orifice transluminal endoscopic surgery (NOTES) performed transvaginally. The surgery, which consisted of a hybrid NOTES procedure using a transvaginal approach, was performed on an emergency basis by the surgical team on call. The indications for surgery were acute cholecystitis (n = 6), acute appendicitis (n = 2), and pelvic peritonitis (n = 2) with intra-abdominal infection. The procedure was successfully performed in all patients using a dual-channel endoscope and mini-laparoscopy assistance. This is the first clinical series in which NOTES has been performed on an emergency basis to treat intra-abdominal infections. Transvaginal surgery for intra-abdominal infection is a feasible procedure for groups experienced in the elective NOTES approach.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (Notes): Surgical Technique and Results

“…Since then, this access has been used to perform several procedures, including nephrectomy (Branco et al, 2008b;Castillo et al, 2009;Kaouk et al, 2010;Ribal Caparrós et al, 2009), tubal sterilization (Kondo et al, 2009), liver resection (Noguera et al, 2008), sleeve gastrectomy (Fischer et al, 2009;Ramos et al, 2008b), adjustable gastric banding (Michalik et al, 2010), incisional hernia repair (Jacobsen et al, 2010), cancer diagnostic staging (Zorrón et al, 2008), splenectomy (Targarona et al, 2009), retroperitoneoscopy (Zorron et al, 2010a) among others. More recently, some case series have been published (Alcaraz et al, 2010;Asakuma et al, 2009;Cuadrado-Garcia et al, 2011;Hackethal et al, 2010;Horgan et al, 2009;Lehmann et al, 2010;Niu et al, 2010;Noguera et al, 2009;Noguera et al, 2010;Palanivelu et al, 2008;Pugliese et al, 2010;Ramos et al, 2008a;Sotelo et al, 2010;Zornig et al, 2010a;Zornig et al, 2010b;Zorron et al, 2010b). In China (Niu et al, 2010), cholecystectomies were successfully performed via laparoscopic assisted endoscopic transvaginal s u r g e r y .…”

“…Transvaginal Natural Orifice Transluminal Endoscopic Surgery (Notes): Surgical Technique and Results Noguera et al (2010) described 10 women with intra-abdominal infections treated successfully with using hybrid NOTES by transvaginal access. The procedure was performed on an emergency basis by the surgical team on call.…”

Laparoscopic cholecystectomy: consensus conference-based guidelines

“…Surveys have also proved a theoretical good acceptance of the transvaginal route by women but less acceptance by male partners [221,222]. There are still only a few reports on emergency surgery for acute cholecystitis (on six patients) [223]. A new application of NOTES in the acute setting (endoscopic ultrasound guided cholecystostomy) appears promising in selected patients [217].…”

Surgical management of acute cholecystitis

“…It may be performed entirely via the natural orifice or using a hybrid technique which involves laparoscopic support via an umbilical port [80]. In a small case series of ten patients [82], six emergency NOTES transvaginal cholecystectomies for acute cholecystitis were successfully performed. The mean operative time was 86.5 min and there were no general or wound complications.…”