Transvaginal natural orifice transluminal endoscopic surgery for adnexal masses.

AIM

Natural orifice transluminal endoscopic surgery (NOTES) is currently a very important topic for surgeons. This study aimed to describe the initial clinical experience of transvaginal NOTES for adnexal masses and investigate its feasibility and surgical outcome.

METHODS

We performed transvaginal NOTES in seven patients with adnexal masses through a 2-cm incision in the posterior vaginal fornix. A transvaginal NOTES system comprising a wound protractor and a surgical glove with sheaths was used. Resection was performed according to the method of standard laparoscopic adnexal surgery. The adnexal mass was removed via the incision of the posterior vaginal fornix after complete resection.

RESULTS

Since June 2011, seven patients have undergone transvaginal NOTES for adnexal masses. All cases were completed successfully without conversion to standard laparoscopic approach. The median age of the patients was 48 years (range, 36-60) and the median body mass index was 23.6 (range, 20.4-25.3). The median tumor size was 6 cm (range, 3.7-6.7). The median operative time was 45 min (range, 40-80). The estimated blood loss was minimal (range, 5-300 mL). The median postoperative hospital stay was 2 days (range, 1-3). No postoperative complications were observed at follow-up. All the patients were very satisfied with the cosmetic result.

CONCLUSION

The findings show transvaginal NOTES with our method to be a feasible, safe and effective surgical technique that results in excellent cosmesis. It may be an alternative technique for the treatment of properly selected female patients with adnexal masses. More experience and instrumental improvement suitable for transvaginal NOTES are needed.