title: Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for adnexal tumors.
abstract: BACKGROUND
  Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) has shown promise as a minimally invasive laparoscopic surgery technique.
  
  
  OBJECTIVE
  To investigate the feasibility and surgical outcome of E-NOTES for adnexal tumors.
  
  
  METHODS
  We performed E-NOTES in 12 patients with adnexal tumors through a 2-cm intraumblical incision. A single-port access system comprising a wound protractor and a surgical glove was used. A prospective data registry was used in this study.
  
  
  RESULTS
  Since 1 July 2008, 12 patients have undergone E-NOTES for adnexal tumors. E-NOTES in all 12 cases was completed successfully without conversion to standard laparoscopic approach. Median operative time for creating an E-NOTES access system and the ensuing operative procedures was 6 min (range 5-15 min) and 73 min (range 25-110 min), respectively. Median blood loss was <10 ml. No complications requiring treatment occurred.
  
  
  CONCLUSIONS
  E-NOTES is a feasible alternative method for resection of adnexal tumors with better cosmetic outcome. More experience and instrumental improvement suitable for E-NOTES are needed.
authors.affiliation: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea.
authors.forename: Myong Cheol
authors.initials: MC
authors.lastname: Lim
authors.forename: Tae-Joong
authors.initials: TJ
authors.lastname: Kim
authors.forename: Sokbom
authors.initials: S
authors.lastname: Kang
authors.forename: Duk-Soo
authors.initials: DS
authors.lastname: Bae
authors.forename: Sang-Yoon
authors.initials: SY
authors.lastname: Park
authors.forename: Sang-Soo
authors.initials: SS
authors.lastname: Seo