title: Hybrid transvaginal and transumbilical laparoendoscopic adnexal surgery.
abstract: BACKGROUND
  Natural orifice translumenal endoscopic surgery (NOTES) is an emerging concept in the recent literature that could lead to potential benefits in clinical applications. The present study describes the initial clinical application in 15 cases of hybrid transvaginal and transumbilical NOTES and discusses the feasibility, safety, and potential benefits of the method.
  
  
  METHODS
  We evaluated the records of 15 patients who underwent hybrid transvaginal and transumbilical laparoendoscopic adnexal surgery between January 2010 and September 2011.
  
  
  RESULTS
  Procedures included salpingo-oophorectomy (n=7) and cystectomy (n=3) for ovarian tumors and salpingectomy (n=5) for unruptured tubal pregnancy. The mean operative time was 79 minutes (range, 49-116 minutes). Blood loss was minimal in all cases. All procedures were successfully performed, and there were no conversions to conventional multiport laparoscopy or open surgery. Gynecologic examination after 3 months showed no negative findings, and the cosmetic result was ideal with no visible scar.
  
  
  CONCLUSIONS
  Hybrid transvaginal and transumbilical NOTES is feasible and safe in select patients, and it provides no visible scar.
authors.affiliation: Comprehensive Reproductive Medicine, Regulation of Internal Environment and Reproduction, Systemic Organ Regulation, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. n.yoshiki.crm@tmd.ac.jp
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Yoshiki
authors.forename: Tomomi
authors.initials: T
authors.lastname: Okawa
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kubota
mesh_terms: D000290:Adnexa Uteri / Q000601:surgery*; D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D010051:Ovarian Neoplasms / Q000601:surgery*; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000601:surgery*; D014472:Umbilicus; D014621:Vagina