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.
Similar content being viewed by others
References
Cahill RA (2010) Natural orifice transluminal endoscopic surgery-here and now. Surgeon 8:44–50
McGee MF, Rosen MJ, Marks J, Onders RP, Chak A, Faulx A, Chen VK, Ponsky J (2006) A primer on natural orifice transluminal endoscopic surgery: building a new paradigm. Surg Innov 13:86–93
Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142:823–826 discussion 6–7
Branco AW, Branco Filho AJ, Kondo W, Noda RW, Kawahara N, Camargo AA, Stunitz LC, Valente J, Rangel M (2008) Hybrid transvaginal nephrectomy. Eur Urol 53:1290–1294
Alcaraz A, Peri L, Molina A, Goicoechea I, García E, Izquierdo L, Ribal MJ (2010) Feasibility of transvaginal NOTES-assisted laparoscopic nephrectomy. Eur Urol 57:233–237
Zhang X, Fu B, Lang B, Zhang J, Xu K, Li HZ, Ma X, Zheng T (2007) Technique of anatomical retroperitoneoscopic adrenalectomy with report of 800 cases. J Urol 177:1254–1257
Lang B, Fu B, OuYang JZ, Wang BJ, Zhang GX, Xu K, Zhang J, Wang C, Shi TP, Zhou HX, Ma X, Zhang X (2008) Retrospective comparison of retroperitoneoscopic versus open adrenalectomy for pheochromocytoma. J Urol 179:57–60
Zacharias M, Haese A, Jurczok A, Stolzenburg JU, Fornara P (2006) Transperitoneal laparoscopic adrenalectomy: outline of the preoperative management, surgical approach, and outcome. Eur Urol 49:448–459
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R Jr (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208
Durani P, McGrouther DA, Ferguson MW (2009) The patient scar assessment questionnaire: a reliable and valid patient-reported outcomes measure for linear scars. Plast Reconstr Surg 123:1481–1489
Ramacciato G, Mercantini P, La Torre M, Di Benedetto F, Ercolani G, Ravaioli M, Piccoli M, Melotti G (2008) Is laparoscopic adrenalectomy safe and effective for adrenal masses larger than 7 cm? Surg Endosc 22:516–521
Cindolo L, Gidaro S, Neri F, Tamburro FR, Schips L (2010) Assessing feasibility and safety of laparoendoscopic single-site surgery adrenalectomy: initial experience. J Endourol 24:977–980
Jeong BC, Park YH, Han DH, Kim HH (2009) Laparoendoscopic single-site and conventional laparoscopic adrenalectomy: a matched case-control study. J Endourol 23:1957–1960
Perretta S, Allemann P, Asakuma M, Dallemagne B, Marescaux J (2009) Adrenalectomy using natural orifice translumenal endoscopic surgery (NOTES): a transvaginal retroperitoneal approach. Surg Endosc 23:1390
Fritscher-Ravens A, Ghanbari A, Cuming T, Kahle E, Niemann H, Koehler P, Patel K (2008) Comparative study of NOTES alone versus EUS-guided NOTES procedures. Endoscopy 40:925–930
Sotelo R, de Andrade R, Fernández G, Ramirez D, Di Grazia E, Carmona O, Moreira O, Berger A, Aron M, Desai MM, Gill IS (2010) NOTES hybrid transvaginal radical nephrectomy for tumor: stepwise progression toward a first successful clinical case. Eur Urol 57:138–144
Kaye DR, Storey BB, Pacak K, Pinto PA, Linehan WM, Bratslavsky G (2010) Partial adrenalectomy: underused first line therapy for small adrenal tumors. J Urol 184:18–25
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.
Author information
Authors and Affiliations
Corresponding authors
Additional information
Rights and permissions
About this article
Cite this article
Zou, X., Zhang, G., Xiao, R. et al. Transvaginal natural orifice transluminal endoscopic surgery (NOTES)-assisted laparoscopic adrenalectomy: first clinical experience. Surg Endosc 25, 3767–3772 (2011). https://doi.org/10.1007/s00464-011-1786-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1786-y