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Surgical Endoscopy

, Volume 25, Issue 12, pp 3767–3772 | Cite as

Transvaginal natural orifice transluminal endoscopic surgery (NOTES)-assisted laparoscopic adrenalectomy: first clinical experience

  • Xiaofeng ZouEmail author
  • Guoxi Zhang
  • Rihai Xiao
  • Yuanhu Yuan
  • Gengqing Wu
  • Xiaoning Wang
  • Dazhi Long
  • Yuting Wu
  • Min Liu
  • Yijun Xue
  • Xu ZhangEmail author
Article

Abstract

Background

This study aimed to describe the initial clinical experience of transvaginal natural orifice transluminal endoscopic surgery (NOTES)-assisted laparoscopic adrenalectomy (TNLA) and to evaluate its feasibility and efficacy.

Methods

Between May and December 2010, 11 consecutive women were subjected to TNLA for adrenal tumors at the authors’ center. With the patient under general anesthesia, a 5-mm trocar and a 10-mm trocar were inserted in the umbilical edge for conventional operating apparatus, and a 10-mm trocar was inserted in the posterior vaginal fornix for a conventional 30º laparoscope. Dissection was performed according to the method of a standard laparoscopic adrenalectomy. The adrenal gland, its tumor, or both were put into a homemade bag and then removed via the incision of the posterior vaginal fornix after complete resection.

Results

A total of 11 TNLAs were performed in this series. Only one conversion to open surgery was performed for one patient with Cushing disease, who was subjected to a splenectomy synchronously for an injury of the spleen. Except for this patient, no patients required a blood transfusion. The median operative time was 102 min (range 80–310 min), and the median estimated blood loss was 80 ml (range 30–800 ml). The median size of the mass in terms of the largest diameter was 4.7 cm (range 2.2–6.6 cm). There was no difference between pre- and postoperative median Female Sexual Function Index (FSFI) total scores (P = 0.102). All the patients except the one who had conversion to open surgery were very satisfied with the cosmetic result.

Conclusions

The findings show TNLA to be a feasible and effective surgical technique that results in excellent cosmesis. It may be an alternative technique for the treatment of properly selected female patients with adrenal tumor.

Keywords

Adrenalectomy Laparoscopy NOTES Transvaginal approach 

Notes

Acknowledgment

The authors are grateful to Jun Yang, Hui Xu, Folin Liu, Yunfeng Liao, and Xin Zhong for assistance in writing the manuscript.

Disclosures

Xiaofeng Zou, Guoxi Zhang, Rihai Xiao, Yuanhu Yuan, Gengqing Wu, Xiaoning Wang, Dazhi Long, Yuting Wu, Min Liu, Yijun Xue, and Xu Zhang have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Xiaofeng Zou
    • 1
    Email author
  • Guoxi Zhang
    • 1
  • Rihai Xiao
    • 1
  • Yuanhu Yuan
    • 1
  • Gengqing Wu
    • 1
  • Xiaoning Wang
    • 1
  • Dazhi Long
    • 1
  • Yuting Wu
    • 1
  • Min Liu
    • 1
  • Yijun Xue
    • 1
  • Xu Zhang
    • 2
    Email author
  1. 1.Department of UrologyFirst Affiliated Hospital of Gannan Medical UniversityGanzhouPeople’s Republic of China
  2. 2.Department of Urology, Clinical Division of SurgeryChinese PLA General HospitalBeijingChina

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