Transvaginal Laparoscopic Appendectomy Simultaneously with Vaginal Hysterectomy: Icing on the Cake

Yu Tian, MD, PhD, Shuodong Wu, Yinghan Chen, Danbo Wang. Department of General Surgery,Shengjing Hospital, China Medical University.

Background: Natural orifice transluminal endoscopic surgery ( NOTES) involves the introduction of instruments through a natural orifice into the peritoneal cavity to perform surgical interventions. The vagina is the most widely used approach to NOTES. We report the utilization of the vaginal opening at the time of vaginal hysterectomy as a natural orifice for laparoscopic appendectomy.

Materials and Methods: We reviewed cases of ten patients with chronic appendicitis who underwent transvaginal laparoscopic appendectomy simultaneously with vaginal hysterectomy. A laparoscopic approach was established after removal of the uterus, and the appendix was removed transvaginally. Among the cases, five were conducted under gasless laparoscopy by using a simple abdominal wall-lifting instrument.

Results: All procedures were performed successfully without intraoperative or major postoperative complications. The appendectomy portion of the procedure took
approximately 15 minutes to 35 minutes. All patients were discharged 3 days after surgery without external scars.

Conclusions: Transvaginal appendectomy with rigid laparoscopic instruments following vaginal hysterectomy appears to be a feasible and safe modification of established techniques with acceptable outcomes.

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