title: Poor man's NOTES: can it be a good approach for adhesiolysis? A first case report with video demonstration.
abstract: OBJECTIVE
  To show that in selected cases transvaginal NOTES can be a frugally innovative approach for adhesiolysis and that it can be performed in a low-cost setting.
  
  
  METHODS
  Step-by-step explanation of the technique using videos and pictures (educative video).
  
  
  METHODS
  A 51-year old (para 2, gravida 2) presented with meso- and hypogastric pain. Two years before, an umbilical hernia had been repaired using a Proceed Ventral Patch mesh. The diagnosis of pain caused by adhesions was made, and laparoscopic adhesiolysis was planned. On ultrasound, a small left ovarian fibroma was visualized. Because of the suspected umbilical location of the adhesions, we decided to use a transvaginal NOTES approach to perform adhesiolysis and left adnexectomy. Pathological examination confirmed a small benign papillary serous adenofibroma of the ovary.
  
  
  METHODS
  A transvaginal NOTES approach to perform adhesiolysis combined with left adnexectomy using only standard reusable laparoscopic instruments and a low-cost self-constructed NOTES port.
  
  
  RESULTS
  The procedure and postoperative recovery were uneventful. No minor or major complications occurred. The patient has been cured of her pain.
  
  
  CONCLUSIONS
  Transvaginal NOTES is a novel approach that requires further validation. This case report shows that transvaginal NOTES can be used to perform adhesiolysis for abdominal pain and that it can be performed in a low-cost setting without the need for expensive ports or disposable instruments.
authors.affiliation: Department of Gynaecology and Obstetrics, AZ Imelda Hospital, Bonheiden, Belgium. Electronic address: jan.baekelandt@imelda.be.
authors.forename: Jan
authors.initials: J
authors.lastname: Baekelandt
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D057605:Natural Orifice Endoscopic Surgery; D000267:Tissue Adhesions / Q000473:pathology / Q000601:surgery*; D014472:Umbilicus / Q000473:pathology* / Q000601:surgery*; D014621:Vagina / Q000473:pathology / Q000601:surgery*
keywords: Adhesiolysis; Frugal innovation; Laparoscopy; NOTES