title: Salpingo-Oophorectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery.
abstract: Vaginal hysterectomy is the preferred route of hysterectomy in benign gynecologic disease; however, a vaginal salpingo-oophorectomy can sometimes be technically challenging. Even the most skilled vaginal surgeon will occasionally have to convert to an abdominal approach to complete the procedure.
  
  
  
  After a vaginal hysterectomy, if the surgeon is struggling to safely complete a salpingo-oophorectomy, a natural orifice transluminal endoscopic surgery (NOTES) approach could be considered. A single port is placed in the vagina and after achieving pneumoperitoneum, an endoscope is introduced to perform a survey of the pelvis and lower abdomen. The salpingo-oophorectomy can then be completed under direct visualization by using conventional laparoscopic instruments through the vaginal port.
  
  
  
  Salpingo-oophorectomy was successfully completed in six unembalmed cadavers and in two live patients.
  
  
  
  At the time of difficult vaginal salpingo-oophorectomy, the use of a NOTES approach could circumvent the need to convert to an abdominal route. It provides clear visualization of the entire pelvic and abdominal area and is technically feasible.
authors.affiliation: Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Karl
authors.initials: K
authors.lastname: Jallad
authors.forename: Lauren
authors.initials: L
authors.lastname: Siff
authors.forename: Tonya
authors.initials: T
authors.lastname: Thomas
authors.forename: Marie Fidela R
authors.initials: MF
authors.lastname: Paraiso
mesh_terms: D000368:Aged; D002102:Cadaver; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D010052:Ovariectomy / Q000379:methods*; D058994:Salpingectomy / Q000379:methods*; D014621:Vagina