Natural Orifice Transluminal Endoscopic Surgery Has Cosmetic Benefits

A surgical patient’s likelihood of leaving the operating suite or surgeon’s office with only small incisions is substantial today. In addition to smaller incisions, other benefits include less pain, lower infection risk, less blood loss, shorter hospital stays, and faster recovery.

Though advances in the field include robotic surgery, laparoscopic surgery, thoracoscopic surgery, and surgeries that fall under the “keyhole surgery” umbrella, natural orifice transluminal endoscopic surgery (NOTES) — which is most often performed through the mouth or vagina — is the latest and fastest-growing minimally invasive surgical technique. Compared to open and endoscopic surgery, NOTES causes less abdominal wall trauma and trocar site-related complications. Once the abdomen is accessed, the surgeon performs the procedure using a transabdominal needle with laparoscopic instruments or no extra instruments.

Since 2007, the transvaginal approach (TA) to general surgery procedures has been used to facilitate adrenalectomy, appendectomy, cholecystectomy, colectomy, culdoscopy, donor nephrectomy, hysterectomy, liver resection, rectosigmoidectomy, sleeve gastrectomy, and splenectomy. However, surgeons still consider the approach to be experimental, and they have concerns about safety with regard to fertility, sexual function, and other site-related complications.

Researchers from the Department of Surgery at the University of California at San Diego (UCSD) recently evaluated a hybrid TA’s safety and feasibility in abdominal organ extraction. They conducted a retrospective review using data from an ongoing prospective nonrandomized series of patients operated on between September 2007 and January 2012.

The study group consisted of 34 female participants who presented to the UCSD surgery clinic for elective cholecystectomy or sleeve gastrectomy, or who were referred for appendectomy by emergency room personnel. According to the researchers, 82% of patients underwent cholecystectomy, 9% had appendectomies, and 9% had sleeve gastrectomies.

All patients underwent surgeries using the transvaginal technique, and no patients required conversion to open or laparoscopic surgery. The researchers reported that the median pain score on day 1 was a 5 out of 10, which was adequately addressed with oral narcotics. Within a week, the median score decreased to a 1 out of 4.

The study authors followed the patients for a median of 18 months. Six patients reports spotting or heavy menses that resolved over time, while 2 women became pregnant and delivered vaginally with no complications.

The study suggested that TA is safe and cosmetically advantageous with no appreciable effect on future fertility or sexual function.

“TA may prove to be a superior mode of organ extraction, although randomized studies and long-term follow-up are needed,” the authors concluded.