Back to Annual Meeting Program

Background: the clinical application of NOTES procedures have raised issues regarding the ways of access to the abdomen. The transvaginal access has been long and widely used and eliminates the disadvantages and risks associated with other NOTES approaches. With the development of laparoscopic techniques, the vagina was used not only as a port of entry but also as an excellent channel for removal of surgical specimens. The easy closure of the incision and the minimal risk of infection represent some of the benefits of this access, outweighting the other NOTES alternatives.
Objective: to present the followup of our first 107 patients who were operated on through a hybrid NOTES transvaginal access
Methods and materials: after institutional IRB approval a program of NOTES surgery was started at our single institution in august 2007. Between that date and august 2009 107 procedures were attempted (100 cholecystectomies and 7 appendectomies) with a colposcopic NOTES approach with hybrid technique. The average age was 33.5 years with ranges between 22 to 46. After discharge, refrain from sexual activity was prescribed for 15 days (first 30 patients) and for 30 days in the following patients, due to inobservance. The postoperative follow up included gynecologic assessment at postoperative days 7, 30, 60, 180 and 360. The evaluation included: guided questionnaire, physical examination and colposcopy to assess healing, presence of anatomical injuries, vaginal secretion and other alterations.
Results: the cholecystectomy with the NOTES colposcopic hybrid technique could be completed in 99 of the 100 patients (95 %). In the remaining case the operation had to be performed laparoscopically due to pelvic adhesions (5 previous cesarean sections). One case ( # 6) required a minilaparotomy through a previous Pfannestiel incision for checking hemostasis of the vaginal cul de sac and 8 required the placement of an additional 2.5 mm trocar. The appendectomy was completed in all 7 cases, in 2 with the placement of an additional 2.3 mm trocar. No major complications were attained.
The systematic assessment proved adequate healing of the vaginal access with no local complications as well as absence of granulomas, hematomas, adhesions or retractions. None of the patients refer dyspareunia. Thirteen patients (12%) got pregnant after the procedure, 10 with a normal birth delivery and 3 cesarean sections, without complications due to the previous access
Conclusions: the colposcopic NOTES access has proved to be safe, with excellent outcomes, no complications and void of sequelae in the gynecologic and sexual aspects. The risks of rectal injury, infection and sexual or pregnancy dysfunctions are considered to be minimal.