[Transvaginal hybrid natural orifice translumenal endoscopic surgery appendectomy]

Norihito Wada

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Natural orifice translumenal endoscopic surgery (NOTES) is considered the ultimate minimally invasive intervention for visceral disease. The transvaginal route is now the only one that can be used for NOTES procedures in daily clinical practice. We performed hybrid NOTES appendectomy that was preevaluated and approved by the Japan NOTES and Institutional Review Board. A 5-mm trocar was inserted transumbilically and used for laparoscope access. An additional transumbilical 2.3-mm port was placed, through which the surgeon inserted a grasper. We created a transvaginal port with a long 12-mm trocar. Laparoscopic instruments such as a vessel sealing system, surgical staplers, and a retrieval bag were introduced, and the surgical technique consequently became safer, although the access route was limited. The appendix was removed transvaginally. The patient did not need epidural anesthesia or any pain medication. The cosmetic results were better than that of conventional single-port surgery. Triangulation is achieved in this procedure, which makes the surgery easier. To generalize NOTES to many types of surgery and enable it to be performed in men, the transgastric approach is essential. The development of flexible instruments designed for NOTES is also necessary.

Original languageEnglish
Pages (from-to)308-311
Number of pages4
JournalNihon Geka Gakkai zasshi
Issue number6
Publication statusPublished - 2013 Nov 1
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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