title: Natural orifice transluminal endoscopic surgery-assisted versus laparoscopic ovarian cystectomy (NAOC vs. LOC): a case-matched study.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) has shown its prospection as a minimally invasive endoscopic surgery. This study aimed to examine the safety and efficacy of combined NOTES and vaginal approach, natural orifice transluminal endoscopic surgery-assisted ovarian cystectomy (NAOC), in the conservative management of benign ovarian tumors.
  
  
  METHODS
  Records were reviewed for the 34 consecutive NAOC procedures between May 2011 and March 2014. Age, body mass index, parity, size of the mass, and bilaterality of the mass were used to select comparable patient who had undergone laparoscopic ovarian cystectomy (LOC).
  
  
  RESULTS
  A total of 277 patients were recruited in this study (243 LOCs and 34 NAOCs, respectively). There was no incidence of switching to abdominal laparotomy. Length of operation and length of postoperative stay were significantly greater in the LOC group than in the NAOC group, but total hospital charges were similar in both groups. There was no difference in febrile morbidity between the two groups but more estimated blood loss (EBL) in NAOC group, although EBL was <50 mL in the two groups. Linear correlations of mass size with operating time and EBL existed in LOC group, but not in NAOC group.
  
  
  CONCLUSIONS
  NAOC can be safely performed for benign and large ovarian tumors. Besides, NAOC offers a superior operative efficiency compared with LOC.
authors.affiliation: Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, Taiwan. wang2260@cgmh.org.tw.|Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan. wang2260@cgmh.org.tw.
authors.forename: Chin-Jung
authors.initials: CJ
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Chilung, Taiwan.
authors.forename: Pei-Yin
authors.initials: PY
authors.lastname: Wu
authors.affiliation: Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, Taiwan.|Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan.
authors.forename: Hsin-Hong
authors.initials: HH
authors.lastname: Kuo
authors.affiliation: Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, Taiwan.|Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan.
authors.forename: Hsing-Tse
authors.initials: HT
authors.lastname: Yu
authors.affiliation: Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5, Fu-Hsin Street, Kwei-Shan, Taoyuan, Taiwan.|Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan.
authors.forename: Chen-Ying
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsiao-Tseng
authors.initials: HT
authors.lastname: Tseng
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D017722:Hospital Charges; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D061646:Operative Time; D010048:Ovarian Cysts / Q000601:surgery*; D055815:Young Adult
keywords: Cystectomy; Laparoscopy; NOTES; Natural orifice transluminal endoscopic surgery; Ovary