The Transvaginal Approach in Acute Appendicitis

Pérez, Raúl Castro; González, Luis Ramón Acosta; Reyes, Eduardo Dopico; Fernández, Juan Carlos Delgado; Arias, Luis E Robaina; Estrada, Martha Oriolo

doi:10.1016/j.cireng.2011.02.003

Cited by 4 publications

(14 citation statements)

References 54 publications

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“…Patients who had a larger uterus required a laparoscopic colpotomy incision, and if the patient had an adnexal infection and appendicitis, only the 5 mm umbilical trocar was used [ 15 , 21 ]. The appendix was then held using either a grasper, rat-tooth biopsy forceps, or curved grasping forceps to hold the appendix [ 13 , 16 , 22 , 25 , 26 ]. If the appendix was retrocecal, the retroperitoneal structures, bowel attachments, and mesoappendix were freed [ 21 ].…”

Section: Reviewmentioning

confidence: 99%

“…Following TVA, some patients received no analgesics as the pain was reported as 0, others received either one dose of parenteral analgesics, and others received PCA morphine for 12 hours postoperation [ 10 , 12 , 14 , 17 , 22 , 25 ]. When pain was reported, standard steps toward analgesia were employed per the surgeon’s preference, and those on PCA had a mean usage of 8.7 mg of morphine [ 16 , 17 ]. Most studies reported no intra-operative complications, such as excess blood loss or transvaginal gas leakage, nor the need to convert to a conventional LA [ 11 , 12 , 14 , 19 , 25 ].…”

Section: Reviewmentioning

confidence: 99%

“…Women who were included in the study to receive TVA had acute appendicitis, chronic appendicitis when there was no filling of the appendix during barium enema, more than one attack of acute appendicitis, presence of a fecalith, delivery of at least one child, between 18 and 65 years old, and non-perforated appendicitis [15][16][17][18][19]. The average age of women who underwent TVA was 37.4, with a mean BMI of 30.63 mg/k 2 [16,[20][21][22][23][24]. Women also tended to be young, non-pregnant, married with families, thin-built, and did not have pelvic inflammatory disease [22].…”

Section: Indicationsmentioning

confidence: 99%

“…Women also tended to be young, non-pregnant, married with families, thin-built, and did not have pelvic inflammatory disease [22]. Women were excluded if they had retrocecal appendix, were pregnant, had past abdominal or gynecological surgery, had complicated appendicitis like appendicular abscess, were virgins, had gynecological infections, aged <18 or >65, had pelvic adhesions, had prior malignancy, chemotherapy, or BMI >35 kg/m 2 [13,[16][17][18][19][20]22]. Despite the BMI limitations, two publications performed surgery on women with a BMI over 35 kg/m 2 to test whether it is a true contraindication [23,25].…”

Section: Indicationsmentioning

confidence: 99%

“…The application of the TVA was relatively consistent across studies, with minor variation in the surgeon's preference for objects like sutures or techniques in suturing. Before surgery, patients receive prophylactic antibiotics such as cefuroxime, metronidazole, amoxicillin, clavulanic acid, gentamicin, or cefazolin [11,[14][15][16][19][20][21]26]. Patients were then induced with endotracheal anesthesia and placed in a low lithotomy position in Allen stirrups [11][12][13]16,18,19,21,22,[25][26][27].…”

Section: Transvaginal Laparoscopic Appendectomy Proceduresmentioning

confidence: 99%

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Transvaginal Laparoscopic Appendectomy: A Systematic Review

Slouha,

Biput,

Krumbach

et al. 2024

Cureus

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Appendectomy remains the gold standard for treating appendicitis, but advancements in laparoscopic techniques have shifted the paradigm. Natural orifice transluminal endoscopic surgery (NOTES) and transvaginal appendectomy (TVA) offer a potentially less invasive alternative to traditional laparoscopic appendectomy (LA). This article systematically reviews the procedures, perceptions, and complications of TVA to assess its viability as a surgical option. Between January 1, 2003, and November 1, 2023, 4832 case reports, case series, and experimental and observational peer-reviewed publications were examined and filtered using the keyword "Transvaginal Laparoscopic Appendectomy." The publications were screened using PRISMA guidelines, and 20 studies were included for analysis and review. Survey results showed that women's acceptance of TVA was 43%, citing reduced invasiveness as a major reason for positive reception. TVA procedures exhibited consistency, with variations in appendectomy methods, appendix removal, and posterior fornix incision closure. Positive outcomes included shorter operation times, reduced postoperative pain, and minimal scarring. Complications were uncommon but included bladder puncture, urinary tract infections, and intra-abdominal abscesses. Indications primarily focused on surgical safety, reduced scarring, and postoperative benefits. Sexual function post-TVA exhibited no significant differences in most cases, with a recovery period of two to four weeks. This systematic review suggests that TVA is a promising alternative to traditional LA, offering potential advantages in terms of postoperative complications. While the existing literature indicates positive outcomes, further research with larger sample sizes and long-term follow-ups is needed to validate the efficacy and safety of TVA and assess how the procedure impacts the reproductive function of patients.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Section: Transvaginal Laparoscopic Appendectomy Proceduresmentioning

confidence: 99%

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Transvaginal Laparoscopic Appendectomy: A Systematic Review

Slouha,

Biput,

Krumbach

et al. 2024

Cureus

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Transvaginal Appendectomy in Morbidly Obese Patient

Yağcı

Kayaalp

Ateş

2014

Case Reports in Surgery

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Introduction. Laparoscopic appendectomy has significant benefits in obese patients. However, morbid obesity can be accepted as an exclusion criterion for natural orifice transluminal endoscopic surgery (NOTES). Here, we present a transvaginal appendectomy in a 66-year-old morbidly obese (BMI 36 kg/m2, ASA III) patient. Case and Technique. Acute appendicitis was suspected based on history, physical examination, laboratory tests, and ultrasound findings. During laparoscopic surgery, a 5 mm trocar was inserted through the umbilicus and a 5 mm telescope was placed. A 12 mm trocar and a 5 mm grasper were inserted separately through the posterior fornix of the vagina under laparoscopic guidance. The appendix was divided with an endoscopic stapler through the transvaginal 12 mm trocar and removed from the same trocar. The operating time was 75 minutes with minimal blood loss (<10 mL). The patient was discharged 16 hours after surgery uneventfully and she did not require any analgesic administration. Conclusion. To the best of our knowledge, this is the first clinical case that focuses on the transvaginal appendectomy at morbid obesity. We can say that morbid obesity does not constitute an obstacle for treatment of acute appendicitis by transvaginal endoscopic surgery.

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Transvaginal Appendectomy: A Systematic Review

Yağcı

Kayaalp

2014

Minimally Invasive Surgery

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Background. Natural orifice transluminal endoscopic surgery (NOTES) is a new approach that allows minimal invasive surgery through the mouth, anus, or vagina. Objective. To summarize the recent clinical appraisal, feasibility, complications, and limitations of transvaginal appendectomy for humans and outline the techniques. Data Sources. PubMed/MEDLINE, Cochrane, Google-Scholar, EBSCO, clinicaltrials.gov and congress abstracts, were searched. Study Selection. All related reports were included, irrespective of age, region, race, obesity, comorbidities or history of previous surgery. No restrictions were made in terms of language, country or journal. Main Outcome Measures. Patient selection criteria, surgical techniques, and results. Results. There were total 112 transvaginal appendectomies. All the selected patients had uncomplicated appendicitis and there were no morbidly obese patients. There was no standard surgical technique for transvaginal appendectomy. Mean operating time was 53.3 minutes (25–130 minutes). Conversion and complication rates were 3.6% and 8.2%, respectively. Mean length of hospital stay was 1.9 days. Limitations. There are a limited number of comparative studies and an absence of randomized studies. Conclusions. For now, nonmorbidly obese females with noncomplicated appendicitis can be a candidate for transvaginal appendectomy. It may decrease postoperative pain and enable the return to normal life and work off time. More comparative studies including subgroups are necessary.

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The Transvaginal Approach in Acute Appendicitis

Cited by 4 publications

References 54 publications

Transvaginal Laparoscopic Appendectomy: A Systematic Review

Transvaginal Laparoscopic Appendectomy: A Systematic Review

Transvaginal Appendectomy in Morbidly Obese Patient

Transvaginal Appendectomy: A Systematic Review

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