Transvaginal NOTES Nephrectomy

Abstract

Natural orifice translumenal endoscopic surgery (NOTES) nephrectomy has been reported by several centers. Between May 2010 and January 2015, we have performed 178 transvaginal NOTES nephrectomies. Eighteen of these underwent pure transvaginal NOTES nephrectomies. At first, two umbilical trocars and one transvaginal trocar were used during the procedure. Then, one umbilical trocar and a transvaginal multi-instrument access port were used. At last, there was no umbilical trocar. Dissection was performed according to the method of a standard laparoscopic transabdominal nephrectomy. The specimen was placed inside a homemade bag and removed through an extended incision at the posterior vaginal fornix. Transvaginal NOTES nephrectomy was successfully completed in 172 patients. Five patients were converted to open surgery, and 1 patient was converted to suprapubic-assisted laparoendoscopic single-site surgery. At a mean range follow-up of 51.8 (10–69) months, the posterior colpotomy incision healed well, and the scars were nearly invisible on the abdominal wall. The female sexual function index (FSFI) questionnaire showed that transvaginal NOTES nephrectomy did not affect the female sexual function. Therefore, NOTES nephrectomy using the vagina as an entry point to the peritoneal cavity is very promising.