title: Minilaparoscopy-assisted natural orifice surgery.
abstract: OBJECTIVE
  New technology has allowed us to perform major abdominal and pelvic surgeries with increasingly smaller instruments. The ultimate goal is surgery with no visible scars. Until current technical limitations are overcome, minilaparoscopy-assisted natural orifice surgery (MANOS) provides a solution. The aim of this study was to examine our clinical and experimental experience with MANOS.
  
  
  METHODS
  Minilaparoscopic abdominal instruments were used together with a large vaginal port, which was used for insufflation, visual purposes, introduction of operative instruments, and specimen extraction. Minilaparoscopy-assisted intraperitoneal transgastric appendectomy was done in simulators (Lap trainer with SimuVision, Simulab Corp., Seattle, WA).
  
  
  RESULTS
  Since 1998, we have used this technique in 100 cases including ovarian cystectomies, oophorectomies, salpingo-oophorectomies, myomectomies, appendectomies, and cholecystectomies. Some oophorectomies were performed after vaginal hysterectomy in cases where vaginal extraction was not possible. In this case series, we had only one complication, a case of postoperative fever after an ovarian cystectomy, which was diagnosed as drug-related fever. Our limited simulator experience showed that MANOS is a feasible technique for performing transgastric appendectomies.
  
  
  CONCLUSIONS
  It may take several years for natural orifice surgery to become standard care. Meanwhile, MANOS could encourage and expedite this process.
authors.affiliation: The Mount Sinai Hospital of Queens, Department of Minimally Invasive Surgery, Long Island City, New York 11102, USA. LaserGYN@aol.com
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Tsin
authors.forename: Liliana T
authors.initials: LT
authors.lastname: Colombero
authors.forename: Johann
authors.initials: J
authors.lastname: Lambeck
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Manolas
mesh_terms: D000005:Abdomen / Q000601:surgery*; D001062:Appendectomy / Q000295:instrumentation; D003464:Culdoscopy; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008904:Miniaturization