Vol 91, No 1 (2020)
Research paper
Published online: 2020-01-31

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Transvaginal salpingo-oophorectomy with gasless laparoscopy — an optional pure natural orifice transluminal endoscopic surgery

Tingting Liu1, Yinghan Chen1, Xinyou Wang1
Pubmed: 32039460
Ginekol Pol 2020;91(1):1-5.


Objectives: To establish the appropriate technique for salpingo-oophorectomy via transvaginal natural orifice transluminal
endoscopic surgery (NOTES), under gasless laparoscopy.
Material and methods: Ten patients with clinical indication underwent gasless laparoscopic transvaginal salpingo-oophorectomy
with concurrent vaginal hysterectomy. An abdominal-wall lifting device was used after removal of the uterus,
and the adnexa was removed trans-vaginally by gasless laparoscopy. The perioperative clinical data, such as operative
duration, volume of blood loss, morbidity, intraoperative and postoperative complications, and length of hospital stay,
were retrospectively analyzed.
Results: All procedures were successfully done, without any intraoperative or major postoperative complications, and no
additional transabdominal ports were required. The salpingo-oophorectomy part of the procedure was completed in approximately
11–40 minutes, with minimal blood loss. All of the patients were discharged, scar-free, 2–4 days after surgery.
Conclusions: Transvaginal NOTES with gasless laparoscopy is a feasible and safe surgical technique in cases involving difficult
vaginal salpingo-oophorectomy, which avoids conversion to an abdominal route.

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  1. Aarts JWM, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015(8): CD003677.
  2. Kho RM, Magrina JF. Round Ligament Technique and Use of a Vessel-sealing Device to Facilitate Complete Salpingectomy at the Time of Vaginal Hysterectomy. J Minim Invasive Gynecol. 2015; 22(6): 1084–1087.
  3. Jallad K, Siff L, Thomas T, et al. Salpingo-Oophorectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery. Obstet Gynecol. 2016; 128(2): 293–296.
  4. Tsin DA, Bumaschny E, Helman M, et al. Culdolaparoscopic oophorectomy with vaginal hysterectomy: an optional minimal-access surgical technique. J Laparoendosc Adv Surg Tech A. 2002; 12(4): 269–271.
  5. Sewell T, Courtney H, Tawfeek S, et al. The feasibility and safety of transvaginal bilateral salpingo-oophorectomy. Int J Gynaecol Obstet. 2018; 141(3): 344–348.
  6. Terzi H, Turkay U, Uzun ND, et al. Hysterectomy and salpingo-oophorectomy by transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) assisted by an umbilical camera: Case report and new hybrid technique in gynecology. Int J Surg Case Rep. 2018; 51: 349–351.
  7. Moen MD, Richter HE. Vaginal hysterectomy: past, present, and future. Int Urogynecol J. 2014; 25(9): 1161–1165.
  8. Yoshiki N. Review of transvaginal natural orifice transluminal endoscopic surgery in gynecology. Gynecol Minim Invasive Ther. 2017; 6(1): 1–5.
  9. Kayaalp C. Pure Transvaginal Appendectomy Versus Traditional Laparoscopic Appendectomy: More Procedure Time but Less Length of Hospital Stay. Ann Surg. 2015; 262(6): e109.
  10. Chen YH, Wang DB, Tian Yu, et al. Pure NOTES transvaginal appendectomy with gasless laparoscopy. J Surg Res. 2014; 186(1): 179–183.
  11. Heaney N. A report of 565 vaginal hysterectomies performed for benign pelvic disease. American Journal of Obstetrics and Gynecology. 1934; 28(5): 751–755.
  12. Baekelandt J. Transvaginal natural orifice transluminal endoscopic surgery: a new approach to ovarian cystectomy. Fertil Steril. 2018; 109(2): 366.
  13. Liu J, Kohn J, Fu H, et al. Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Sacrocolpopexy: A Pilot Study of 26 Cases. J Minim Invasive Gynecol. 2019; 26(4): 748–753.
  14. Kale A, Sarıibrahim B, Başol G. Hysterectomy and salphingoopherectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery(NOTES): Turkish surgeons' initial experience. Int J Surg. 2017; 47: 62–68.
  15. Wei D, Han Y, Li M, et al. Pure retroperitoneal natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy using standard laparoscopic instruments: a safety and feasibility study in a porcine model. BMC Urol. 2016; 16(1): 29.
  16. Liu QW, Han T, Yang M, et al. A systematic review on efficacy and safety of gasless laparoscopy in the management of uterine leiomyoma. J Huazhong Univ Sci Technolog Med Sci. 2016; 36(1): 142–149.
  17. Jallad K, Walters MD. Natural Orifice Transluminal Endoscopic Surgery (NOTES) in Gynecology. Clin Obstet Gynecol. 2017; 60(2): 324–329.
  18. Yang YS, Oh KY, Hur MH, et al. Laparoendoscopic single-site surgery using conventional laparoscopic instruments and glove port technique in gynecology: a single surgeon's experience. J Minim Invasive Gynecol. 2015; 22(1): 87–93.
  19. Lee SC, Kim KY, Yoon SN, et al. Feasibility of gasless laparoscopy-assisted transumbilical appendectomy: early experience. J Laparoendosc Adv Surg Tech A. 2014; 24(8): 538–542.
  20. Li SH, Deng J, Huang FT, et al. Impact of gasless laparoscopy on circulation, respiration, stress response, and other complications in gynecological geriatrics. Int J Clin Exp Med. 2014; 7(9): 2877–2882.
  21. Poon C, Hyde S, Grant P, et al. Incidence and Characteristics of Unsuspected Neoplasia Discovered in High-Risk Women Undergoing Risk Reductive Bilateral Salpingooophorectomy. Int J Gynecol Cancer. 2016; 26(8): 1415–1420.
  22. Sandberg EM, la Chapelle CF, van den Tweel MM, et al. Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017; 295(5): 1089–1103.
  23. Chen Y, Li J, Zhang Y, et al. Transvaginal Single-Port Laparoscopy Sacrocolpopexy. J Minim Invasive Gynecol. 2018; 25(4): 585–588.