title: Transvaginal natural orifice transluminal endoscopic surgery for adnexal masses.
abstract: OBJECTIVE
  Natural orifice transluminal endoscopic surgery (NOTES) is currently a very important topic for surgeons. This study aimed to describe the initial clinical experience of transvaginal NOTES for adnexal masses and investigate its feasibility and surgical outcome.
  
  
  METHODS
  We performed transvaginal NOTES in seven patients with adnexal masses through a 2-cm incision in the posterior vaginal fornix. A transvaginal NOTES system comprising a wound protractor and a surgical glove with sheaths was used. Resection was performed according to the method of standard laparoscopic adnexal surgery. The adnexal mass was removed via the incision of the posterior vaginal fornix after complete resection.
  
  
  RESULTS
  Since June 2011, seven patients have undergone transvaginal NOTES for adnexal masses. All cases were completed successfully without conversion to standard laparoscopic approach. The median age of the patients was 48 years (range, 36-60) and the median body mass index was 23.6 (range, 20.4-25.3). The median tumor size was 6 cm (range, 3.7-6.7). The median operative time was 45 min (range, 40-80). The estimated blood loss was minimal (range, 5-300 mL). The median postoperative hospital stay was 2 days (range, 1-3). No postoperative complications were observed at follow-up. All the patients were very satisfied with the cosmetic result.
  
  
  CONCLUSIONS
  The findings show transvaginal NOTES with our method to be a feasible, safe and effective surgical technique that results in excellent cosmesis. It may be an alternative technique for the treatment of properly selected female patients with adnexal masses. More experience and instrumental improvement suitable for transvaginal NOTES are needed.
authors.affiliation: Department of Obstetrics and Gynecology, Eulji University, Daejeon, Korea.
authors.forename: Yun Seok
authors.initials: YS
authors.lastname: Yang
authors.forename: Myung Haeng
authors.initials: MH
authors.lastname: Hur
authors.forename: Kwoan Young
authors.initials: KY
authors.lastname: Oh
authors.forename: Soo Young
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000291:Adnexal Diseases / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000706:statistics & numerical data*; D010052:Ovariectomy; D056910:Republic of Korea; D012189:Retrospective Studies
keywords: adnexal mass; minimally invasive surgery; single port; transvaginal natural orifice transluminal endoscopic surgery