title: Transvaginal laparoscopic appendectomy simultaneously with vaginal hysterectomy: initial experience of 10 cases.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) involves the introduction of instruments through a natural orifice into the peritoneal cavity to perform surgical interventions. The vagina is the most widely used approach to NOTES. We report the utilization of the vaginal opening at the time of vaginal hysterectomy as a natural orifice for laparoscopic appendectomy.
  
  
  METHODS
  We reviewed cases of 10 patients with chronic appendicitis who underwent transvaginal laparoscopic appendectomy simultaneously with vaginal hysterectomy. A laparoscopic approach was established after removal of the uterus, and the appendix was removed transvaginally. Among the 10 cases, 5 were conducted under gasless laparoscopy by using a simple abdominal wall-lifting instrument.
  
  
  RESULTS
  All procedures were performed successfully without intraoperative or major postoperative complications. The appendectomy portion of the procedure took approximately 21 minutes to 34 minutes. All patients were discharged less than 4 days after surgery, without external scars.
  
  
  CONCLUSIONS
  Transvaginal appendectomy with rigid laparoscopic instruments following vaginal hysterectomy appears to be a feasible and safe modification of established techniques, with acceptable outcomes.
authors.affiliation: Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China (mainland).
authors.forename: Yu
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang, China (mainland).
authors.forename: Shuo-Dong
authors.initials: SD
authors.lastname: Wu
authors.affiliation: Department of Gynecology, Shengjing Hospital, China Medical University, Shenyang, China (mainland).
authors.forename: Ying-Han
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Department of Gynecology, Shengjing Hospital, China Medical University, Shenyang, China (mainland).
authors.forename: Dan-Bo
authors.initials: DB
authors.lastname: Wang
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D014621:Vagina