J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text HTML] [Full Text PDF] （in Japanese / 370KB） [Members Only]

J.Jpn. Surg. Soc.. 114(6): 308-311, 2013

Feature topic

TRANSVAGINAL HYBRID NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY APPENDECTOMY

1) Department of Surgery, Keio University, Tokyo, Japan
2) Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
3) Department of Obstetrics and Gynecology, Keio University, Tokyo, Japan

Norihito Wada1), Minoru Tanabe2), Fumio Kataoka3), Yuko Kitagawa1)

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.

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