title: Transvaginal natural orifice transluminal endoscopic surgery (NOTES)-assisted laparoscopic adrenalectomy: first clinical experience.
abstract: BACKGROUND
  This study aimed to describe the initial clinical experience of transvaginal natural orifice transluminal endoscopic surgery (NOTES)-assisted laparoscopic adrenalectomy (TNLA) and to evaluate its feasibility and efficacy.
  
  
  METHODS
  Between May and December 2010, 11 consecutive women were subjected to TNLA for adrenal tumors at the authors' center. With the patient under general anesthesia, a 5-mm trocar and a 10-mm trocar were inserted in the umbilical edge for conventional operating apparatus, and a 10-mm trocar was inserted in the posterior vaginal fornix for a conventional 30º laparoscope. Dissection was performed according to the method of a standard laparoscopic adrenalectomy. The adrenal gland, its tumor, or both were put into a homemade bag and then removed via the incision of the posterior vaginal fornix after complete resection.
  
  
  RESULTS
  A total of 11 TNLAs were performed in this series. Only one conversion to open surgery was performed for one patient with Cushing disease, who was subjected to a splenectomy synchronously for an injury of the spleen. Except for this patient, no patients required a blood transfusion. The median operative time was 102 min (range 80-310 min), and the median estimated blood loss was 80 ml (range 30-800 ml). The median size of the mass in terms of the largest diameter was 4.7 cm (range 2.2-6.6 cm). There was no difference between pre- and postoperative median Female Sexual Function Index (FSFI) total scores (P = 0.102). All the patients except the one who had conversion to open surgery were very satisfied with the cosmetic result.
  
  
  CONCLUSIONS
  The findings show TNLA to be a feasible and effective surgical technique that results in excellent cosmesis. It may be an alternative technique for the treatment of properly selected female patients with adrenal tumor.
authors.affiliation: Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 23, Qing Nian Road, Ganzhou, Jiangxi 341000, People's Republic of China. gyfyurology@126.com
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Zou
authors.forename: Guoxi
authors.initials: G
authors.lastname: Zhang
authors.forename: Rihai
authors.initials: R
authors.lastname: Xiao
authors.forename: Yuanhu
authors.initials: Y
authors.lastname: Yuan
authors.forename: Gengqing
authors.initials: G
authors.lastname: Wu
authors.forename: Xiaoning
authors.initials: X
authors.lastname: Wang
authors.forename: Dazhi
authors.initials: D
authors.lastname: Long
authors.forename: Yuting
authors.initials: Y
authors.lastname: Wu
authors.forename: Min
authors.initials: M
authors.lastname: Liu
authors.forename: Yijun
authors.initials: Y
authors.lastname: Xue
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D002921:Cicatrix / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D012725:Sexual Behavior; D016896:Treatment Outcome