Hybrid transvaginal and transumbilical laparoendoscopic adnexal surgery.

BACKGROUND: Natural orifice translumenal endoscopic surgery (NOTES) is an emerging concept in the recent literature that could lead to potential benefits in clinical applications. The present study describes the initial clinical application in 15 cases of hybrid transvaginal and transumbilical NOTES and discusses the feasibility, safety, and potential benefits of the method. PATIENTS AND METHODS: We evaluated the records of 15 patients who underwent hybrid transvaginal and transumbilical laparoendoscopic adnexal surgery between January 2010 and September 2011. RESULTS: Procedures included salpingo-oophorectomy (n=7) and cystectomy (n=3) for ovarian tumors and salpingectomy (n=5) for unruptured tubal pregnancy. The mean operative time was 79 minutes (range, 49-116 minutes). Blood loss was minimal in all cases. All procedures were successfully performed, and there were no conversions to conventional multiport laparoscopy or open surgery. Gynecologic examination after 3 months showed no negative findings, and the cosmetic result was ideal with no visible scar. CONCLUSIONS: Hybrid transvaginal and transumbilical NOTES is feasible and safe in select patients, and it provides no visible scar.

Single-incision laparoscopic myomectomy with intracorporeal suturing.

OBJECTIVE: To assess the feasibility, safety, and operative outcomes of single-incision laparoscopic myomectomy with intracorporeal suturing. DESIGN: Retrospective descriptive study. SETTING: Tokyo Medical and Dental University Hospital, Tokyo, Japan. PATIENT(S): Twelve patients who underwent single-incision laparoscopic myomectomy between July 2009 and June 2010 to remove single or multiple uterine myomas. INTERVENTION(S): All cases of single-incision laparoscopic myomectomy were performed by a single surgeon (N.Y.). MAIN OUTCOME MEASURE(S): Technical feasibility and operative outcomes. RESULT(S): Cases consisted of six subserosal, four intramural, and two submucosal myomas. The mean operative time and weight of the largest myoma per patient were 100 minutes (range, 52-150 minutes) and 78 g (range, 15-284 g), respectively. Blood loss was minimal in all cases. All procedures were successfully performed, and there were no conversions to conventional multiport laparoscopy or open surgery. There were no postoperative complications or port-site hernias noted. CONCLUSION(S): We successfully performed single-incision laparoscopic myomectomy with intracorporeal suturing. Single-incision laparoscopic myomectomy with the glove wound retractor system is feasible and safe in select patients, and it provides almost no visible scar.