title: Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES--world's first report.
abstract: BACKGROUND
  Natural orifice translumenal endoscopic surgery (NOTES) is the newest technique emerging in the field of surgery. There are several techniques described in the literature; however there is no standardization yet. We describe the transvaginal approach for endoscopic appendectomy in humans, probably the world's first report.
  
  
  METHODS
  Pneumoperitoneum was achieved via a Veress needle in the umbilicus. Routine 12-mm endoscope and routine instruments were used. Peritoneal access was gained via a transvaginal approach through the posterior fornix.
  
  
  RESULTS
  Out of a total of six patients, a totally endoscopic transvaginal appendectomy was successfully performed for one patient. The other five patients were either converted to conventional laparoscopy or aided by a laparoscope. The average age of the patients was 29.5 years. The mean operating time was 103.5 min. Hospital stay was 1-2 days. The follow-ups were scheduled at 7 days, 30 days, 90 days, and 6 months. The vaginal wound was examined by the gynecologist and found to have completely healed during the first and second follow-up.
  
  
  CONCLUSIONS
  So far in humans, transgastric appendectomy and cholecystectomy, and transvaginal cholecystectomy have been reported. A transvaginal endoscopic appendectomy in humans has not been reported yet. The transvaginal approach provided a normal image of the target organ, unlike the inverted image of a transgastric approach caused by the inability to manipulate the scope outside the mouth. The technical ease of the procedure and early outcome seem satisfactory, although comparative studies are needed to confirm this.
authors.affiliation: GEM Hospital & Postgraduate Institute, 45-A Pankaja Mill Road, Coimbatore, 641045, India.
authors.forename: Chinnusamy
authors.initials: C
authors.lastname: Palanivelu
authors.forename: Pidigu Seshiyer
authors.initials: PS
authors.lastname: Rajan
authors.forename: Muthukumaran
authors.initials: M
authors.lastname: Rangarajan
authors.forename: Ramakrishnan
authors.initials: R
authors.lastname: Parthasarathi
authors.forename: Palanisamy
authors.initials: P
authors.lastname: Senthilnathan
authors.forename: Mohan
authors.initials: M
authors.lastname: Prasad
mesh_terms: D001062:Appendectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*; D014945:Wound Healing; D055815:Young Adult