title: The first report on hybrid NOTES adjustable gastric banding in human.
abstract: BACKGROUND
  Despite their current limitations, metabolic surgery and natural orifice transluminal endoscopic surgery (NOTES), set new horizons. In this article, the first three cases of adjustable gastric banding (AGB) through transvaginal access in obese women are described.
  
  
  METHODS
  In the General and Vascular Surgery Department, Ceynowa Hospital, Poland, three cases of AGB through the transvaginal access in hybrid, laparoscopically assisted NOTES technique were performed. All patients were female with BMI range 35-37. A dual-channel endoscope and regular laparoscopic instruments were used.
  
  
  RESULTS
  The mean operating time was 110 min. Indometacin was given intravenously PRN for postoperative pain. None of the patients required more than 3 g of indometacin and for longer than 24 h postoperatively. None required opioids either. There was one major complication of iatrogenic damage to the ureter, which required subsequent hospitalisation and laparoscopic repair. Hospitalisation time was 2 days. During 2 months follow up, the mean weight loss was 15 kg. There were no malpositions of the band. There was no early mortality in the study group.
  
  
  CONCLUSIONS
  Feasibility of the proposed hybrid laparoscopically assisted NOTES adjustable gastric banding was proved. It is a technically demanding procedure, requiring appropriate endoscopic and laparoscopic skills. To avoid ureteric damage one should acquire safe colpotomy skills before commencing transvaginal NOTES operations.
authors.affiliation: General and Vascular Surgery Department, Ceynowa Hospital, Jagalskiego 10, Wejherowo, 84-200, Poland. michs1@wp.pl
authors.forename: Maciej
authors.initials: M
authors.lastname: Michalik
authors.forename: Michal
authors.initials: M
authors.lastname: Orlowski
authors.forename: Maciej
authors.initials: M
authors.lastname: Bobowicz
authors.forename: Agata
authors.initials: A
authors.lastname: Frask
authors.forename: Anna
authors.initials: A
authors.lastname: Trybull
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D009765:Obesity / Q000601:surgery; D016896:Treatment Outcome; D014513:Ureter / Q000293:injuries; D014621:Vagina; D015431:Weight Loss