Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Surgical Staging of Early-Stage Ovarian Cancers: A Report of Two Cases

Abstract

Surgical staging is essential in the management of ovarian cancers. This staging has traditionally been performed by laparotomy, but minimally invasive techniques are increasingly employed. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a promising technique in the field of gynecological oncology. We report 2 cases of vNOTES surgical staging for suspicious ovarian tumors. We operated on 2 patients aged of 81 and 62 years for low-grade serous ovarian carcinoma and ovarian cystadenofibroma, respectively. We performed surgical staging with a pure vNOTES technique for the first patient and used a hybrid approach for the second. No intraoperative or postoperative complications were observed. We suggest that vNOTES is a feasible and effective approach to surgically manage early-stage ovarian cancers.

Sentinel Node Biopsy for Endometrial Cancer by Retroperitoneal Transvaginal Natural Orifice Transluminal Endoscopic Surgery: A Preliminary Study

“…The role of vNOTES in ovarian cancer has yet to be defined. Although surgical staging by vNOTES could be feasible in early-stage ovarian cancers ( 34 , 35 ), some concerns could be associated with its realization, such as the risk of upstaging in the case of ovarian rupture and the risk of understaging due to limited accessibility of some anatomical regions, such as the prevesical peritoneum, costodiaphragmatic recesses, Morrison's pouch, and intestinal mesentery. vNOTES seems an interesting surgical approach for the management of vulnerable cancer patients, for whom one should pay particular attention to postoperative recovery and timing to adjuvant chemo-/radiotherapy.…”

Analysis and suggestions on the complications in 2000 cases of transvaginal natural orifice transluminal endoscopic surgery: Can it be a conventional surgery?

“…Since the first vNOTES of the adnexa was reported in 2012, [1][2][3] this approach has been widely used in various gynecologic procedures, such as salpingectomy, ovarian cyst removal, adnexectomy, hysterectomy, lymphadenectomy (sentinel, dissection), and pelvic floor repair. [3][4][5][6][7][8] Compared with laparoendoscopic single-site surgery (LESS), vNOTES has the advantages of mild postoperative pain, earlier anal exhaust time, and the absence of superficial scarring. [9][10][11][12][13] However, as a new surgical approach, perioperative complications are crucial assessment indicators in addition to confirming the feasibility and advantages of vNOTES.…”

“…[14][15][16] Most studies on vNOTES focus on its feasibility without adequately analyzing the complications. 5,6,[17][18][19] Moreover, the possibility of underreporting complications cannot be denied when a researcher evaluates his own surgical technique. Most current reports are limited to a specific procedure such as hysterectomy, making it difficult to identify common problems associated with vNOTES.…”

“…However, as a new surgical approach, perioperative complications are crucial assessment indicators in addition to confirming the feasibility and advantages of vNOTES 14–16 . Most studies on vNOTES focus on its feasibility without adequately analyzing the complications 5,6,17–19 . Moreover, the possibility of underreporting complications cannot be denied when a researcher evaluates his own surgical technique.…”

Optimization and demonstration of two types of spring-roll dielectric elastomer actuators for minimally invasive surgery

“…In particular, the slender and rigid structure of traditional MIS instruments can only provide a limited range of hardness and accuracy, which can not meet the requirements of precision medical surgical tasks ( Vajsbaher et al, 2018 ). In some common minimally invasive medical procedures, such as single-port laparoscopic surgery (SPLS) or natural orifice endoscopic surgery (NOTES), the whole body of an MIS instrument should work through a narrow single hole ( Tei et al, 2021 ; Hurni et al, 2022 ), where the surgical field and flexibility of the operation are severely constrained. To deal with the above problems, novel actuators should be designed with adequate mechanical simplicity and robustness to obtain better flexibility and maneuverability.…”