title: Transvaginal organ extraction: potential for broad clinical application.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery procedures have evolved over the past few years. A transvaginal approach is a promising alternative for intraperitoneal procedures. Our objective was to evaluate the safety and feasibility of transvaginal organ extraction.
  
  
  METHODS
  This institutional review board-approved protocol involved retrospective review of an ongoing prospective study. Female subjects who presented to our hospital for elective cholecystectomy, appendectomy, or sleeve gastrectomy were offered participation in the study. Eligible patients met the following criteria: age between 18 and 75, diagnosis of gallbladder disease, acute appendicitis, or morbid obesity who desired surgical treatment. A hybrid transvaginal natural orifice approach was used in this series.
  
  
  RESULTS
  Thirty-four women underwent transvaginal organ extraction between September 2007 and January 2012. The mean age was 40 ± 12.1 years (range 23-63 years). The mean body mass index was 27 ± 6.4 kg/m(2) (range 16-43 kg/m(2)). All patients had an American Society of Anesthesiologists classification of two or below. The mean operative time for cholecystectomy, appendectomy, and sleeve gastrectomy was 90, 71, and 135 min, respectively. There were no conversions to open operation and no intraoperative complications. The mean hospital stay was 2 days for all cases. Patients were followed for a mean of 24 months (range 1-61 months). There were two pregnancies and two successful vaginal deliveries. Six patients (18 %) had minor complaints of spotting or heavy menses in the immediate postoperative period that resolved with conservative measures. There were no abdominal wall complications. There were no long-term complications and no mortalities.
  
  
  CONCLUSIONS
  This initial experience suggests that this surgical approach is safe, does not increase length of stay, and has no long-term vaginal complications. Given this attractive profile, a transvaginal approach may prove to be a superior mode of organ extraction, although randomized studies and long-term follow-up are needed.
authors.affiliation: Department of Surgery, University of California at San Diego, San Diego, CA, USA.
authors.forename: Garth R
authors.initials: GR
authors.lastname: Jacobsen
authors.forename: Juan S
authors.initials: JS
authors.lastname: Barajas-Gamboa
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Coker
authors.forename: Joslin
authors.initials: J
authors.lastname: Cheverie
authors.forename: C Aitor
authors.initials: CA
authors.lastname: Macias
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Sandler
authors.forename: Mark A
authors.initials: MA
authors.lastname: Talamini
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D015992:Body Mass Index; D002763:Cholecystectomy / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies; D014621:Vagina; D055815:Young Adult