title: NOTES-assisted transvaginal splenectomy: the next step in the minimally invasive approach to the spleen.
abstract: OBJECTIVE
  Natural orifice transluminal endoscopic surgery (NOTES) has marked yet another step forward in less-invasive surgical procedures. Access to solid organs located deep in the left hypochondrium can be difficult using this technique but the transvaginal approach with the patient positioned in full lateral decubitus may be an option.
  
  
  METHODS
  We present the case of a 60-year-old woman with a symptomatic splenic polycystic tumor. The procedure was carried out by a multidisciplinary team using a standard flexible videogastroscope and endoscopic instruments. Transvaginal visualization of the spleen and standard dissection of attachments were feasible, and splenectomy was completed using transvaginal stapling of the splenic hilum. The organ was extracted transvaginally.
  
  
  RESULTS
  The postoperative course was uneventful. The patient had minimal postoperative pain and minimal scars, and was discharged on the second postoperative day.
  
  
  CONCLUSIONS
  Transvaginal access can be safely used for operative visualization, hilum transection, and spleen removal with conventional instrumentation, reducing parietal wall trauma to a minimum. The clinical, esthetic, and functional advantages require further analysis.
authors.affiliation: Service of Surgery, the Endoscopy Unit, Hospital de Sant Pau, UAB, Barcelona, Spain. 13882ets@comb.es
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Targarona
authors.forename: Cristina
authors.initials: C
authors.lastname: Gomez
authors.forename: Ramon
authors.initials: R
authors.lastname: Rovira
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Pernas
authors.forename: Carmen
authors.initials: C
authors.lastname: Balague
authors.forename: Carlos
authors.initials: C
authors.lastname: Guarner-Argente
authors.forename: Sergio
authors.initials: S
authors.lastname: Sainz
authors.forename: Manuel
authors.initials: M
authors.lastname: Trias
mesh_terms: D000368:Aged; D003560:Cysts / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D013156:Splenectomy / Q000295:instrumentation / Q000379:methods*; D013158:Splenic Diseases / Q000601:surgery*; D014621:Vagina