title: Is the transvaginal route appropriate for intra-abdominal NOTES procedures? Experience and follow-up of 222 cases.
abstract: BACKGROUND
  Since 2007, natural orifice transluminal endoscopic surgery (NOTES) has been applied in humans. We performed this prospective study to evaluate the transvaginal route in terms of risks, complication rate, and long-term side effects such as dyspareunia.
  
  
  METHODS
  From June 2007 to September 2011, we performed 222 transvaginal hybrid NOTES procedures: 220 transvaginal cholecystectomies (TVC) and 2 transvaginal appendectomies (TVA). All patients were asked to present to our associated gynecologists within 1 week for an examination. After at least 3 months, the patients were interviewed using a standard questionnaire.
  
  
  RESULTS
  All operations could be successfully performed in this technique except two cases, which were converted to conventional laparoscopic cholecystectomy. The only intraoperative complication was the puncture of the urine bladder. We observed two postoperative complications: one biliary fistula 3 days after TVC, and one abscess in the Douglas pouch 3 weeks after TVC. The gynecological examinations revealed no abnormalities. The interview (median postoperative time, 6 months) with a follow-up rate of 93 % revealed no pain in the pelvis, dyspareunia, or sexual dysfunction after TVC.
  
  
  CONCLUSIONS
  The transvaginal route is appropriate for NOTES procedures; there is only a minor and acceptable rate of intra- and postoperative morbidity.
authors: Department of Surgery, Israelitisches Krankenhaus, Orchideenstieg 14, 22297 Hamburg, Germany. hamid@mofid.de
authors: Hamid
authors: H
authors: Mofid
authors: Alice
authors: A
authors: Emmermann
authors: Margret
authors: M
authors: Alm
authors: Hans-Albrecht
authors: HA
authors: von Waldenfels
authors: Conrad
authors: C
authors: Felixmüller
authors: Carsten
authors: C
authors: Zornig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000379:methods*; D002763:Cholecystectomy / Q000379:methods*; D004414:Dyspareunia / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina; D055815:Young Adult
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