Surgical Endoscopy

, Volume 26, Issue 11, pp 3316–3316 | Cite as

Pure transvaginal laparoscopic appendectomy

  • Kurt E. RobertsEmail author
  • Dan-Arin Silasi
  • Robert L. Bell
  • Andrew J. Duffy



Natural orifice transluminal endoscopic surgery has been at the forefront of minimally invasive surgery. Benefits include no visible scars, less pain, and shorter recovery time. We describe a video of a 37-year-old female who underwent a pure transvaginal appendectomy (TVA) for acute appendicitis. This is 1 of 18 successfully performed TVAs at Yale-New Haven Hospital. Appropriate Institutional Review Board was obtained preoperatively.


The patient was positioned in steep Trendelenburg and then a weighted speculum was introduced into the vagina allowing exposure of the posterior vaginal fornix. The cervix was grasped with a single-toothed tenaculum on the posterior cervical lip and the posterior vaginal fornix was visualized. Access to the peritoneum was achieved by electrocautery and then sharp dissection. A SILS™ port (Covidien, Mansfield, MA, USA) was introduced and pneumoperitoneum up to 15 mmHg was achieved. Two 5-mm trocars and one 12-mm trocar were used. A 5-mm 30° angled endoscope, a flexible reticulating endograsper, and straight standard instruments were used. The identified appendix was dissected and a stapler was used to divide the mesoappendix from the appendix. Following confirmation of good hemostasis and no spillage of bowel contents, the appendix was removed from the abdomen within a retrieval bag and the culdotomy was closed with a running absorbable suture. The patient tolerated the 27 min procedure well and was discharged home in good condition on postoperative day 1.


Appendix Laparoscopy Appendectomy Transvaginal NOTES Natural orifice surgery 



Dr. Kurt E. Roberts is a co-founder of NovaTract and a Consultant for Covidien. No conflict exists in regards to this manuscript and video. Drs. Dan-Arin Silasi, Robert L. Bell and, Andrew J. Duffy have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 205576 kb)

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Kurt E. Roberts
    • 1
    • 2
    Email author
  • Dan-Arin Silasi
    • 3
  • Robert L. Bell
    • 1
  • Andrew J. Duffy
    • 1
  1. 1.Department of SurgeryYale New Haven Hospital, Yale School of MedicineNew HavenUSA
  2. 2.Section of Gastrointestinal SurgeryYale University School of MedicineNew HavenUSA
  3. 3.Department of GynecologyYale New Haven Hospital, Yale School of MedicineNew HavenUSA

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