Surgical Endoscopy

, Volume 22, Issue 5, pp 1343–1347 | Cite as

Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES—world’s first report

  • Chinnusamy Palanivelu
  • Pidigu Seshiyer Rajan
  • Muthukumaran RangarajanEmail author
  • Ramakrishnan Parthasarathi
  • Palanisamy Senthilnathan
  • Mohan Prasad



Natural orifice translumenal endoscopic surgery (NOTES) is the newest technique emerging in the field of surgery. There are several techniques described in the literature; however there is no standardization yet. We describe the transvaginal approach for endoscopic appendectomy in humans, probably the world’s first report.

Materials and methods

Pneumoperitoneum was achieved via a Veress needle in the umbilicus. Routine 12-mm endoscope and routine instruments were used. Peritoneal access was gained via a transvaginal approach through the posterior fornix.


Out of a total of six patients, a totally endoscopic transvaginal appendectomy was successfully performed for one patient. The other five patients were either converted to conventional laparoscopy or aided by a laparoscope. The average age of the patients was 29.5 years. The mean operating time was 103.5 min. Hospital stay was 1–2 days. The follow-ups were scheduled at 7 days, 30 days, 90 days, and 6 months. The vaginal wound was examined by the gynecologist and found to have completely healed during the first and second follow–up.


So far in humans, transgastric appendectomy and cholecystectomy, and transvaginal cholecystectomy have been reported. A transvaginal endoscopic appendectomy in humans has not been reported yet. The transvaginal approach provided a normal image of the target organ, unlike the inverted image of a transgastric approach caused by the inability to manipulate the scope outside the mouth. The technical ease of the procedure and early outcome seem satisfactory, although comparative studies are needed to confirm this.


NOTES Transvaginal appendectomy Endoscopy 


  1. 1.
    McGee MF, Rosen MJ, Marks J, Onders RP, Chak A, Faulx A et al (2006) A primer on natural orifice transluminal endoscopic surgery: building a new paradigm. Surg Inn 13(2):86–93CrossRefGoogle Scholar
  2. 2.
    Hochberger J, Lamade W (2005) Transgastric surgery in the abdomen: the dawn of a new era? Gastrointest Endosc 62:293CrossRefPubMedGoogle Scholar
  3. 3.
    de la Fuente SG, DeMaria EJ, Reynolds JD, Portenier DD, Pryor AD (2007) New developments in surgery - natural orifice transluminal endoscopic surgery (NOTES). Arch Surg 142:295–297CrossRefGoogle Scholar
  4. 4.
    Fong DG, Pai RD, Thompson CC (2007) Transcolonic abdominal exploration: a NOTES survival study. Gastrointest Endosc 65(2):312–318CrossRefPubMedGoogle Scholar
  5. 5.
    Wilk PJ (1994) Method for use in intra-abdominal surgery. US Patent 5,297,536Google Scholar
  6. 6.
    Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117CrossRefPubMedGoogle Scholar
  7. 7.
    ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery White Paper 2005 (2006) Gastrointest Endosc 63:199–203Google Scholar
  8. 8.
    Wilhelm D, Meining A, von Delius S, Fiolka A, Can S, Hann von Weyhern C (2007) An innovative, safe and sterile sigmoid access (ISSA) for NOTES. Endoscopy 39(5):401–406CrossRefPubMedGoogle Scholar
  9. 9.
    Wagh MS, Merrifield BF, Thompson CC (2005) Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model. Clin Gastroenterol Hepatol 3:892–896CrossRefPubMedGoogle Scholar
  10. 10.
    Swanstrom LL (2007) Beyond endoluminal therapeutic endoscopy. Gastrointest Endosc 66(1):121–122CrossRefPubMedGoogle Scholar
  11. 11.
    Marescaux J, Dallemagne B, Perretta S, Mutter D, Wattiez A, Coumaros D. “Operation Anubis”, presented at the Japanese Congress of Surgery in Osaka on April 6th 2007 & at the Congress of the Society of American Gastrointestinal Endoscopic Surgery (SAGES) in Las Vegas 2007Google Scholar
  12. 12.
    Jagannath SB, Kantsevoy SV, Vaughn CA et al (2005) Peroral transgastric ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc 61:449CrossRefPubMedGoogle Scholar
  13. 13.
    Kantsevoy SV (2006) Transgastric endoscopic splenectomy: is it possible? Surg Endosc 20:522–525CrossRefPubMedGoogle Scholar
  14. 14.
    Pai RD, Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, Thompson CC (2006) Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model. Gastrointest Endosc 64(3):428–434CrossRefPubMedGoogle Scholar
  15. 15.
    Lima E, Rolanda C, Pêgo JM, Henriques-Coelho T, Silva D, Carvalho JL, Correia-Pinto J (2006) Transvesical endoscopic peritoneoscopy: a novel 5 mm port for intra-abdominal scarless surgery. J Urol 176(2):802–805CrossRefPubMedGoogle Scholar
  16. 16.
    Rolanda C, Lima E, Pêgo JM, Henriques-Coelho T, Silva D, Moreira I, Macedo G, Carvalho JL, Correia-Pinto J (2007) Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach (with video)”. Gastrointest Endosc 65(1):111–117CrossRefPubMedGoogle Scholar
  17. 17.
    Tsin DA, Colombero LT, Mahmood D, Padouvas J, Manolas P (2001) Operative culdolaparoscopy: a new approach combining operative culdoscopy, minilaparoscopy. J Am Assoc Gynecol Laparosc 8:438–441CrossRefPubMedGoogle Scholar
  18. 18.
    Tsin DA, Colombero LT, Lambeck J, Manolas P (2007) Minilaparoscopy-Assisted Natural Orifice Surgery. JSLS 11:24–29PubMedGoogle Scholar
  19. 19.
    Bessler M, Stevens P, Milone L et al (2007) Transvaginal cholecystectomy laparoscopically assisted for gallstones: a human case (ET017). Proceedings of the annual meeting of the Society of American Gastrointestinal Endoscopy Surgeons, 2007, Las Vegas, Nevada. Las Vegas: The Society 318Google Scholar
  20. 20.
    Pasricha P et al (2005) A next generation therapeutic endoscope: development of a novel endoluminal surgery system with “birds-eye” visualization and triangulating instruments. Gastrointest Endosc 61: AB106CrossRefGoogle Scholar
  21. 21.
    Fong DG et al (2005) Transcolonic access to the peritoneal cavity using a novel incision and closure device. Gastrointest Endosc 63:AB233CrossRefGoogle Scholar
  22. 22.
    Sclabas GM, Swain P, Swanstrom LL (2006) Endoluminal methods for gastrotomy closure in natural orifice transenteric surgery (NOTES). Surg Innov 13(1):23–30CrossRefPubMedGoogle Scholar
  23. 23.
    Wallace M (2006) Take NOTES (natural orifice transluminal endoscopic surgery). Gastroenterology 131(1):11–12CrossRefGoogle Scholar
  24. 24.
    Rattner D, Kalloo A et al (2006) ASGE/SAGES Working Group on Natural Orifice Transluminal Endoscopic Surgery. Surg Endosc 20:329–333CrossRefPubMedGoogle Scholar
  25. 25.
    Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR™) International Conference on Natural Orifice Translumenal Endoscopic Surgery (NOTES™) []

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Chinnusamy Palanivelu
    • 1
  • Pidigu Seshiyer Rajan
    • 1
  • Muthukumaran Rangarajan
    • 1
    Email author
  • Ramakrishnan Parthasarathi
    • 1
  • Palanisamy Senthilnathan
    • 1
  • Mohan Prasad
    • 1
  1. 1.GEM Hospital & Postgraduate InstituteCoimbatoreIndia

Personalised recommendations