First experience in Switzerland with adnexal surgery by transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES). A single-patient case video

Aim of the study We present the first experience in Switzerland of an adnexal surgery by transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) in an 8 cm presumed benign solid ovarian mass.

Materials and methods A 50 year old patient with a unilateral adnexal mass of 8 cm without signs of malignancy. Unilateral salpingo-oophorectomy and contralateral salpingectomy were performed using the vaginal NOTES approach. After vaginal access via colpotomy into the pouch of Douglas, intra-abdominal insertion of a small wound protector covered by an access port (GelPoint, Applied Medical) to create a pneumovagina and a pneumoperitoneum, consequently. Adnexal surgery was performed using a vessel sealer and classical laparoscopic instruments. The ovarian mass was extracted intact without morcellation through the 4 cm-posterior colpotomy.

Results Operative time was 60 min and hospital stay was one night. No complications occurred during or after the procedure. Pathological results confirm a benign tumor. Feasibility and post-operative patient satisfaction were excellent at 1 week and 1-month follow-up. Return to sexual activity was painless.

Conclusion Scarless adnexal surgery using the vNOTES technique is feasible and offers a real alternative to the standard laparoscopic approach. Limitations are comparable to laparoscopic adnexectomy. Randomized comparative studies need to confirm those affirmations.

Publication History

Article published online:
07 October 2020