title: MA-NOS radical sigmoidectomy: report of a transvaginal resection in the human.
abstract: BACKGROUND
  With available laparoscopic and endoscopic instruments/technology a standard radical sigmoid resection is feasible and safe using transvaginal minilaparoscopic-assisted natural orifice surgery (MA-NOS).
  
  
  METHODS
  The intervention was a transvaginal MA-NOS sigmoidectomy in a 78-year-old woman with a sigmoid adenocarcinoma. Maintaining triangulation the surgeon positioned himself at the right side of the patient and used the transvaginal trocar for dissection and stapling of both the inferior mesenteric vessels and the upper rectum. The colonic resection was performed extracorporeally in the conventional fashion and was followed by an intra-abdominal endoscopically assisted stapled anastomosis.
  
  
  RESULTS
  Advantages of minimally invasive surgery seemed to be enhanced with this hybrid laparoscopic approach. Postoperative course was uneventful. All oncological principles governing resection and management were accomplished and the pathology examination confirmed a T3N1 lesion. The patient was discharged on the fourth postoperative day.
  
  
  CONCLUSIONS
  Transvaginal MA-NOS radical sigmoidectomy is a feasible and oncologically safe procedure. MA-NOS is a realistic option for avoiding the need of assisting incisions and related morbidity in the laparoscopic resection of large intra-abdominal lesions. Combined hybrid laparoscopic NOS in humans (MA-NOS) currently provides a safe and reliable way of defining future clinical applications and advantages of NOS and NOTES. Additionally, it stimulates the active development and evaluation of the underpinning technologies and instrumentation.
authors.affiliation: Department of Gastrointestinal Surgery and Centro de Investigaciones Biomédicas Esther Koplowitz, Institut de Malalties Digestives I Metaboliques, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain. alacy@clinic.ub.es
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Lacy
authors.forename: Salvadora
authors.initials: S
authors.lastname: Delgado
authors.forename: Oscar A
authors.initials: OA
authors.lastname: Rojas
authors.forename: Raúl
authors.initials: R
authors.lastname: Almenara
authors.forename: Anabel
authors.initials: A
authors.lastname: Blasi
authors.forename: Josep
authors.initials: J
authors.lastname: Llach
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D003082:Colectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D012811:Sigmoid Neoplasms / Q000601:surgery*