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Transvaginal hybrid-NOTES appendectomy in routine clinical use: prospective analysis of 13 cases and description of the procedure

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Abstract

Background

Access-related abdominal wall injury is part of the operative trauma in laparoscopic appendectomy and accounts for complications. Minimizing this trauma by entering the abdominal cavity by means of natural orifice transluminal surgery (NOTES) may be achieved by a hybrid-appendectomy procedure using the transvaginal route plus a single transumbilical trocar.

Methods

Thirteen patients were prospectively analyzed following transvaginal-hybrid NOTES appendectomy. For the procedure, rigid instruments are used with the patient in lithotomy position. The procedure is performed with two transvaginal and one transumbilical access-points. The specimen is retrieved transvaginally.

Results

All procedures were performed without additional trocars. No conversions to standard laparoscopy or open surgery were necessary. All procedures were performed in acceptable time (mean 52 min). No intraoperative complications and two (15%) postoperative complications, an infected hematoma and an abscess, occurred. They were smoothly treated with standard techniques including one laparoscopic reoperation (8%). Drain placement or resection of a Meckel’s diverticulum was easily managed without conversion. Gynecological short-term follow-up revealed one complication, which was vaginal fungal infection. It occurred after a 7-day course of antibiotics.

Conclusion

This method is found to be feasible intraoperatively and early postoperatively in terms of possibility to manage a variety of intraoperative findings that may occur during planned appendectomy, low intraoperative complications, and management of postoperative complications using established concepts. We, therefore, consider the procedure safe and continue to offer hybrid-NOTES appendectomy to suitable patients.

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References

  1. Ohmann C, Franke C, Kraemer M, Yang Q (2002) [Status report on epidemiology of acute appendicitis]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 73:769-776

  2. Bulian DR, Knuth J, Sauerwald A, Strohlein MA, Lefering R, Ansorg J, Heiss MM (2013) Appendectomy in Germany—an analysis of a nationwide survey 2011/2012. Int J Colorectal Dis 28:127–138

    Article  PubMed  Google Scholar 

  3. Swank HA, Mulder IM, la Chapelle CF, Reitsma JB, Lange JF, Bemelman WA (2012) Systematic review of trocar-site hernia. Br J Surg 99:315–323

    Article  CAS  PubMed  Google Scholar 

  4. Arezzo A, Zornig C, Mofid H, Fuchs KH, Breithaupt W, Noguera J, Kaehler G, Magdeburg R, Perretta S, Dallemagne B, Marescaux J, Copaescu C, Graur F, Szasz A, Forgione A, Pugliese R, Buess G, Bhattacharjee HK, Navarra G, Godina M, Shishin K, Morino M (2013) The EURO-NOTES clinical registry for natural orifice transluminal endoscopic surgery: a 2-year activity report. Surg Endosc 27:3073–3084

    Article  PubMed  Google Scholar 

  5. Horgan S, Meireles OR, Jacobsen GR, Sandler BJ, Ferreres A, Ramamoorthy S, Savides T, Katagiri T, Dotai T, Sedrak M, Majid SF, Nijhawan S, Talamini MA (2013) Broad clinical utilization of NOTES: is it safe? Surg Endosc 27:1872–1880

    Article  PubMed  Google Scholar 

  6. Bulian DR, Trump L, Knuth J, Cerasani N, Heiss MM (2013) Long-term results of transvaginal/transumbilical versus classical laparoscopic cholecystectomy—an analysis of 88 patients. Langenbecks Arch Surg (Deutsche Gesellschaft fur Chirurgie) 398:571–579

    Article  Google Scholar 

  7. Bulian DR, Trump L, Knuth J, Siegel R, Sauerwald A, Strohlein MA, Heiss MM (2013) Less pain after transvaginal/transumbilical cholecystectomy than after the classical laparoscopic technique: short-term results of a matched-cohort study. Surg Endosc 27:580–586

    Article  PubMed  Google Scholar 

  8. Zornig C, Siemssen L, Emmermann A, Alm M, von Waldenfels HA, Felixmuller C, Mofid H (2011) NOTES cholecystectomy: matched-pair analysis comparing the transvaginal hybrid and conventional laparoscopic techniques in a series of 216 patients. Surg Endosc 25:1822–1826

    Article  PubMed  Google Scholar 

  9. Kilian M, Raue W, Menenakos C, Wassersleben B, Hartmann J (2011) Transvaginal-hybrid vs. single-port-access vs. ‘conventional’ laparoscopic cholecystectomy: a prospective observational study. Langenbecks Arch Surg (Deutsche Gesellschaft fur Chirurgie) 396:709–715

    Article  Google Scholar 

  10. Bulian DR, Knuth J, Cerasani N, Sauerwald A, Lefering R, Heiss MM (2013) Transvaginal/Transumbilical Hybrid-NOTES-Versus 3-Trocar Needlescopic Cholecystectomy: Short-Term Results of a Randomized Clinical Trial. Ann Surg. doi:10.1097/SLA.0000000000000218

  11. Shin EJ, Jeong GA, Jung JC, Cho GS, Lim CW, Kim HC, Song OP (2010) Transvaginal endoscopic appendectomy. J Korean Soc Coloproctol 26:429–432

    Article  PubMed Central  PubMed  Google Scholar 

  12. Panait L, Wood SG, Bell RL, Duffy AJ, Roberts KE (2013) Transvaginal natural orifice transluminal endoscopic surgery in the morbidly obese. Surg Endosc 27:2625–2629

    Article  PubMed  Google Scholar 

  13. Solomon D, Lentz R, Duffy AJ, Bell RL, Roberts KE (2012) Female sexual function after pure transvaginal appendectomy: a cohort study. J Gastrointest Surg 16:183–186 (discussion 186–187)

    Article  PubMed  Google Scholar 

  14. Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Prasad M (2008) Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES—world’s first report. Surg Endosc 22:1343–1347

    Article  PubMed  Google Scholar 

  15. Noguera JF, Cuadrado A, Sanchez-Margallo FM, Dolz C, Asencio JM, Olea JM, Morales R, Lozano L, Vicens JC (2011) Emergency transvaginal hybrid natural orifice transluminal endoscopic surgery. Endoscopy 43:442–444

    Article  CAS  PubMed  Google Scholar 

  16. Uecker J, Luftman K, Ali S, Brown C (2013) Comparable operative times with and without surgery resident participation. J Surg Educ 70:696–699

    Article  PubMed  Google Scholar 

  17. Asarias JR, Schlussel AT, Cafasso DE, Carlson TL, Kasprenski MC, Washington EN, Lustik MB, Yamamura MS, Matayoshi EZ, Zagorski SM (2011) Incidence of postoperative intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc 25:2678–2683

    Article  PubMed  Google Scholar 

  18. Wilton L, Kollarova M, Heeley E, Shakir S (2003) Relative risk of vaginal candidiasis after use of antibiotics compared with antidepressants in women: postmarketing surveillance data in England. Drug Saf 26:589–597

    Article  CAS  PubMed  Google Scholar 

  19. Roberts KE, Solomon D, Mirensky T, Silasi DA, Duffy AJ, Rutherford T, Longo WE, Bell RL (2012) Pure transvaginal appendectomy versus traditional laparoscopic appendectomy for acute appendicitis: a prospective cohort study. Ann Surg 255(2):266–269

    Article  PubMed  Google Scholar 

  20. Hucl T, Saglova A, Benes M, Kocik M, Oliverius M, Valenta Z, Spicak J (2012) Patient and physician perception of natural orifice transluminal endoscopic appendectomy. World J Gastroenterol 18:1800–1805

    Article  PubMed Central  PubMed  Google Scholar 

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Disclosures

Jurgen Knuth, Markus Maria Heiss, and Dirk Rolf Bulian have no conflicts of interest or financial ties to disclose. No funding was received for this paper.

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Authors and Affiliations

  1. Department of Abdominal, Vascular & Transplant Surgery, Witten/Herdecke University, Medical Center Cologne-Merheim, Cologne, Germany

    Jurgen Knuth, Markus Maria Heiss & Dirk Rolf Bulian

  2. Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Kempten, Robert-Weixler-Straße 50, 87439, Kempten, Germany

    Jurgen Knuth

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  1. Jurgen Knuth
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  2. Markus Maria Heiss
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  3. Dirk Rolf Bulian
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Correspondence to Jurgen Knuth.

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Knuth, J., Heiss, M.M. & Bulian, D.R. Transvaginal hybrid-NOTES appendectomy in routine clinical use: prospective analysis of 13 cases and description of the procedure. Surg Endosc 28, 2661–2665 (2014). https://doi.org/10.1007/s00464-014-3523-9

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  • DOI: https://doi.org/10.1007/s00464-014-3523-9

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