title: Safety of culdotomy as a surgical approach: implications for natural orifice transluminal endoscopic surgery.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of culdotomy as a surgical approach to access the peritoneal cavity and discuss its implications for natural orifice transluminal endoscopic surgery (NOTES).
  
  
  METHODS
  A retrospective chart review of women undergoing culdotomy  for tubal sterilization (N 219) between January 1995 and December 2005 was performed. The Accordion Grading System was used for the severity of complications.
  
  
  RESULTS
  No intraoperative complications were noted. Postoperative complications occurred in 7 patients (3.2%): 6 infections  (grade 2) and 1 case of hemorrhage (grade 3). Conversion to laparoscopy was necessary in 10 patients (2.2%) due to anatomical constraints or pelvic adhesions; however, culdotomy with entry into the abdominal cavity was nevertheless successful in all 10 cases. The difference in the proportion  with a history of pelvic surgery between the conversion and nonconversion groups was not statistically significant (P = .068). Patients with BMI ≥30 had a higher conversion rate compared to patients with BMI <30 (11.4% versus 1.5%, P = .011). Tubal sterilization via culdotomy  was successfully performed in all 11 women with no prior vaginal deliveries.
  
  
  CONCLUSIONS
  Culdotomy appears to be a safe surgical approach to access the peritoneal cavity and is associated with a low complication rate. These data support the feasibility and safety of utilizing the  cul-de-sac as an access portal for natural orifice transluminal endoscopic surgery.
authors: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
authors: Mary Catherine
authors: MC
authors: Tolcher
authors: Eleftheria
authors: E
authors: Kalogera
authors: Matthew R
authors: MR
authors: Hopkins
authors: Amy L
authors: AL
authors: Weaver
authors: Juliane
authors: J
authors: Bingener
authors: Sean C
authors: SC
authors: Dowdy
mesh_terms: D000328:Adult; D003464:Culdoscopy / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000592:standards*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013246:Sterilization, Tubal / Q000379:methods*; D016896:Treatment Outcome; D014621:Vagina; D055815:Young Adult