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

Objectives:To establish the appropriate technique for salpingo-oophorectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES), under gasless laparoscopy. Material and methods: 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. Results: 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. Conclusions: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.