Natural orifice translumenal endoscopic surgery (NOTES) appendectomy is an emerging technique for acute appendicitis. Under IRB protocol, a 21-year-old female is explored through a 5mm umbilical port. A dual lumen 15mm transvaginal trocar is placed under direct vision. With cephalad retraction, the mesoappendix is taken with the harmonic scalpel. The appendix is transected with a stapler and removed in a bag through the vaginal port. The colpotomy is closed with absorbable suture. The abdominal incision and colpotomy were well healed one month later. A hybrid laparoscopic-assisted NOTES transvaginal appendectomy is a safe procedure for use in the treatment of acute appendicitis.