Transvaginal salpingo-oophorectomy with gasless laparoscopy - an optional pure natural orifice transluminal endoscopic surgery.

Abstract

To establish the appropriate technique for salpingo-oophorectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES), under gasless laparoscopy. Ten patients with clinical indication underwent gasless laparoscopic transvaginal salpingo-oophorectomy with concurrent vaginal hysterectomy. An abdominal-wall lifting device was used after removal of the uterus, and the adnexa was removed trans-vaginally by gasless laparoscopy. The perioperative clinical data, such as operative duration, volume of blood loss, morbidity, intraoperative and postoperative complications, and length of hospital stay, were retrospectively analyzed. All procedures were successfully done, without any intraoperative or major postoperative complications, and no additional transabdominal ports were required. The salpingo-oophorectomy part of the procedure was completed in approximately 11-40 minutes, with minimal blood loss. All of the patients were discharged, scar-free, 2-4 days after surgery. Transvaginal NOTES with gasless laparoscopy is a feasible and safe surgical technique in cases involving difficult vaginal salpingo-oophorectomy, which avoids conversion to an abdominal route.