title: Pure natural orifice transluminal endoscopic surgery (NOTES) involving peroral endoscopic salpingo-oophorectomy (POESY).
abstract: OBJECTIVE
  Natural orifice transluminal endoscopic surgery (NOTES) is a surgical approach that uses natural orifices to gain access to areas of the body. In the present article, we describe the first transgastric pure NOTES salpingo-oophorectomy, which we call peroral endoscopic salpingo-oophorectomy (POESY).
  
  
  METHODS
  A woman with BRCA1 mutation presented for prophylactic bilateral salpingo-oophorectomy. We offered her the transgastric approach, having performed more than 25 transgastric appendectomies. After gastroscopic incision in the corpus wall, we advanced the gastroscope into the abdominal cavity. Salpingo-oophorectomy was performed with the help of an intrauterine manipulator and a transvaginally introduced 5-mm trocar. The posterior colpotomy was dilated and the specimens were extracted. The gastrotomy was closed with an over-the-scope clip, and the colpotomy with a running suture.
  
  
  RESULTS
  The gastroscope provided excellent optical control and good tissue preparation. Prophylactic bilateral salpingo-oophorectomy was performed successfully via POESY. The patient recovered quickly and was discharged on the third day, with an uneventful follow-up.
  
  
  CONCLUSIONS
  The present case demonstrates the feasibility of transgastric access. The gastroscope provided excellent optical control and good tissue preparation. Therefore, we expect an increasing role of transgastric procedures for diseases in the pelvic region, particularly if new endoscopic platforms with better means of instrumentation and tissue management become available.
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany. Electronic address: amadeus.hornemann@umm.de.
authors.forename: Amadeus
authors.initials: A
authors.lastname: Hornemann
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Suetterlin
authors.affiliation: Institute for Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Trunk
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Gerhardt
authors.affiliation: Central Interdisciplinary Endoscopy, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Kaehler
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000379:methods; D019398:Genes, BRCA1; D006801:Humans; D009154:Mutation; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D010052:Ovariectomy / Q000379:methods*; D058994:Salpingectomy / Q000379:methods*
keywords: BRCA mutation; Bilateral salpingo-oophorectomy; Natural orifice transluminal endoscopic surgery; Peroral endoscopic salpingo-oophorectomy; Transgastric