title: NOTES--case report of a unidirectional flexible appendectomy.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) refers to a new surgical procedure using flexible endoscopes in the abdominal cavity. With this procedure, access is gained by way of organs which are reached through a natural, already-existing external orifice. The hoped-for advantages associated with this method include the reduction of post-operative wound pain, shorter convalescence, avoidance of wound infection and abdominal-wall hernias as well as the absence of scars. We performed a trans-vaginal appendectomy on a human subject.
  
  
  METHODS
  In experimental operations on animals, we first evaluated the trans-vaginal access site. After them, we started first operation in human. The procedure was carried out under preventive administration of antibiotics. We used a therapeutic single-canal gastroscope. The appendix was located after exploration of the abdomen. After preparation of the mesenteriolum, ligature of the appendix base was performed by means of endoloop, followed by transsection with scissors. Recovery of the specimen was achieved by pulling it out with the instrument.
  
  
  RESULTS
  On the evening of the day on which surgery had taken place, administration of nourishment was begun. After the procedure, the patient reported slight soreness in the muscles of the abdominal wall; she felt otherwise perfectly well.
  
  
  CONCLUSIONS
  In the space of a year, the first operations have been performed on human subjects by a few select work groups. NOTES procedures are still in the initial stages of clinical development. Until they can be introduced into surgical daily routine, further improvements are required as to equipment, technology and operative procedure.
authors.affiliation: Department of Interdisciplinary Endoscopy, Medical Center Suedstadt Rostock, Rostock, Germany. joern.bernhardt@kliniksued-rostock.de
authors.forename: Joern
authors.initials: J
authors.lastname: Bernhardt
authors.forename: Bernd
authors.initials: B
authors.lastname: Gerber
authors.forename: Hans-Christof
authors.initials: HC
authors.lastname: Schober
authors.forename: Georg
authors.initials: G
authors.lastname: Kähler
authors.forename: Kaja
authors.initials: K
authors.lastname: Ludwig
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000295:instrumentation / Q000379:methods; D001064:Appendicitis / Q000473:pathology / Q000601:surgery*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal; D004867:Equipment Design; D005260:Female; D006801:Humans; D018583:Pliability; D012008:Recurrence; D016896:Treatment Outcome