Anibal J. Rondan, Rosana Trapani, Gustavo C. Alarcia, Alberto R. Ferreres, Pablo J. Miguel. Bocalandro
The clinical application of NOTES procedures has raised concerns regarding the access to the abdomen. The transvaginal route has been widely used for years and eliminates the disadvantages and risks associated with other NOTES approaches. The easy closure of the incision and the minimal risk of infection represent some of the benefits of this access, nonetheless fertility and functional issues should be cleared
To present the follow-up of consecutive 68 patients who were operated on through a hybrid NOTES transvaginal access
Methods and materials:
Between August 2007 and August 2009, 96 procedures were attempted (94 cholecystectomies and 2 appendectomies) with a colposcopic NOTES approach with hybrid technique. The average age was 31.4 years (range: 18- 48). Refrain from sexual activity was prescribed for 15 days (first 21 patients) and for 30 days in the following patients, due to inobservance. Postoperative follow up included gynecologic assessment at postoperative 7, 30, 60, 180, 360 days, and at 2 and 5 years. The evaluation included: guided questionnaire, physical examination and colposcopy to assess healing, presence of anatomical injuries, vaginal secretion and other alterations.
Trans-vaginal approach with the NOTES colposcopic hybrid technique could be completed in 87 of the 96 patients (90.62%). In the remaining case the operation had to be performed laparoscopically due to pelvic adhesions. One case required a minilaparotomy through a previous Pfannestiel incision for checking hemostasis of the vaginal cul de sac, 3 required the placement of an additional 2.3 mm trocar. The transvaginal appendectomies were completed with the placement of an additional 2.3 mm trocar. No major complications were attained.
The systematic assessment proved adequate healing of the vaginal access with no local complications as well as absence of granulomas, hematomas, adhesions or retractions. None of the patients refer dyspareunia. Eight patients (8.33%) got pregnant after the procedure, 6 with a normal birth delivery and 2 cesarean sections, without complications due to the previous access