Download PDF
Endoscopy 2008; 40(7): 576-580
DOI: 10.1055/s-2008-1077379
Original article

© Georg Thieme Verlag KG Stuttgart · New York

How do gynecologists feel about transvaginal NOTES surgery?

F.  Thele1 , M.  Zygmunt1 , A.  Glitsch2 , C.-D.  Heidecke2 , A.  Schreiber2
  • 1Department of Gynecology and Obstetrics, Greifswald University Hospital, Ernst-Moritz-Arndt University of Greifswald, Germany
  • 2Department of Surgery, Greifswald University Hospital, Ernst-Moritz-Arndt University of Greifswald, Germany
Further Information

Publication History

submitted 9 April 2008

accepted after revision 28 May 2008

Publication Date:
07 July 2008 (online)

Also available at
    Permissions and Reprints

See also:

Commentaire de travail de F. Thele et al., pp. 576Endoscopy 2008; 40(07): 710-710
DOI: 10.1055/s-0032-1306852

Background: Natural-orifice transluminal endoscopic surgery (NOTES) is regarded as safer and less invasive than laparoscopic surgery. However, there has been no documentation of the opinions of surgically active, experienced gynecologists about the indications, contraindications, risks, and complications of transvaginal access.

Methods: A two-page questionnaire was distributed to the heads of the gynecological departments at 181 university and major teaching hospitals across Germany, Austria, and Switzerland. Fifty-two questionnaires (28.7 %) were returned and evaluated. The questionnaire contained ten questions, four of which were yes/no questions and another five of which allowed between four and seven answers. The questionnaire contained one additional open question.

Results: Of the respondents, 69.2 % classified transvaginal access for extrapelvic abdominal surgery as ethical; the remaining 30.8 % described it as experimental. Only 28.8 % would recommend NOTES to their patients if NOTES presented the same surgical risks as the laparoscopic approach. When asked about NOTES-associated complications, 73.1 % mentioned the risk of infection, 61.5 % visceral lesions, 44.2 % infertility, and 34.6 % adhesions. In terms of long-term problems, gynecologists are concerned about dyspareunia and infertility. Adopting their patients’ point of view, 17.3 % voted the lack of scarring compared to laparoscopy as important and 57.6 % as unimportant.

Conclusions: While transvaginal NOTES is argued to be a promising access for scarless surgery, gynecologists mention postoperative infection, visceral lesions, infertility, and adhesions as conceivable complications. Since long-term experience has not yet been achieved, potential problems such as dyspareunia, infertility, and the spread of pre-existing endometriosis remain definitely conceivable complications.

References

  • 1 Schwenk W, Haase O, Neudecker J. et al . Short term benefits for laparoscopic colorectal resection.  Cochrane Database Syst Rev. 2005;  CD003145
    PubMedSearch in Google Scholar
  • 2 Harrell A G, Heniford B T. Minimally invasive abdominal surgery: lux et veritas past, present, and future.  Am J Surg. 2005;  190 239-243
    CrossrefPubMedSearch in Google Scholar
  • 3 Merrifield B F, Wagh M S, Thompson C C. Peroral transgastric organ resection: a feasibility study in pigs.  Gastrointest Endosc. 2006;  63 693-697
    CrossrefPubMedSearch in Google Scholar
  • 4 Bardaro S J, Swanstrom L. Development of advanced endoscopes for Natural Orifice Transluminal Endoscopic Surgery (NOTES).  Minim Invasive Ther Allied Technol. 2006;  15 378-383
    CrossrefPubMedSearch in Google Scholar
  • 5 Baron T H. Natural orifice transluminal endoscopic surgery.  Br J Surg. 2007;  94 1-2
    PubMedSearch in Google Scholar
  • 6 Scott D J, Tang S J, Fernandez R. et al . Completely transvaginal NOTES cholecystectomy using magnetically anchored instruments.  Surg Endosc. 2007;  21 2308-2316
    CrossrefPubMedSearch in Google Scholar
  • 7 Benhidjeb T, Witzel K, Barlehner E, Stark M. The natural orifice surgery concept. Vision and rationale for a paradigm shift [in German].  Chirurg. 2007;  78 537-542
    CrossrefPubMedSearch in Google Scholar
  • 8 Thompson C C. Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model [response to a letter to the editor].  Gastrointest Endosc. 2007;  66 209-210
    CrossrefPubMedSearch in Google Scholar
  • 9 Mintz Y, Horgan S, Cullen J. et al . NOTES: the hybrid technique.  J Laparoendosc Adv Surg Tech A. 2007;  17 402-406
    CrossrefPubMedSearch in Google Scholar
  • 10 Rolanda C, Lima E, Pego J M. et al . Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach (with video).  Gastrointest Endosc. 2007;  65 111-117
    CrossrefPubMedSearch in Google Scholar
  • 11 Meining A, Wilhelm D, Burian M. et al . Development, standardization and evaluation of NOTES cholecystectomy using a transsigmoid approach in the porcine model.  Endoscopy. 2007;  39 860-864
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Kantsevoy S V, Jagannath S B, Niiyama H. et al . Endoscopic gastrojejunostomy with survival in a porcine model.  Gastrointest Endosc. 2005;  62 287-292
    CrossrefPubMedSearch in Google Scholar
  • 13 Pai R D, Fong D G, Bundga M E. et al . Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video).  Gastrointest Endosc. 2006;  64 428-434
    CrossrefPubMedSearch in Google Scholar
  • 14 Rattner D, Kalloo A. ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005.  Surg Endosc. 2006;  20 329-333
    CrossrefPubMedSearch in Google Scholar
  • 15 Marescaux J, Dallemagne B, Perretta S. et al . Surgery without scars: report of transluminal cholecystectomy in a human being.  Arch Surg. 2007;  142 823-826
    CrossrefPubMedSearch in Google Scholar
  • 16 Bessler M, Stevens P D, Milone L. et al . Transvaginal laparoscopically assisted endoscopic cholecystectomy: a hybrid approach to natural orifice surgery.  Gastrointest Endosc. 2007;  66 1243-1245
    CrossrefPubMedSearch in Google Scholar
  • 17 Zornig C, Emmermann A, von Waldenfels H A. et al . Laparoscopic cholecystectomy without visible scar: combined transvaginal and transumbilical approach.  Endoscopy. 2007;  39 913-915
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Zorron R, Filgueiras M, Maggioni L C. et al . NOTES. Transvaginal cholecystectomy: report of the first case.  Surg Innov. 2007;  14 279-283
    PubMedSearch in Google Scholar
  • 19 Zorron R, Maggioni L C, Pombo L. et al . NOTES transvaginal cholecystectomy: preliminary clinical application.  Surg Endosc. 2008;  22 542-547
    CrossrefPubMedSearch in Google Scholar
  • 20 Diekmann A. Empirische Sozialforschung. Grundlagen, Methoden, Anwendungen. Reinbek; Rowohlt 2007
    Search in Google Scholar
  • 21 Bernhardt J, Gerber B, Schober H C. et al . NOTES-case report of a unidirectional flexible appendectomy.  Int J Colorectal Dis. 2008;  23 547-550
    CrossrefPubMedSearch in Google Scholar
  • 22 Palanivelu C, Rajan P S, Rangarajan M. et al . Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES – world’s first report.  Surg Endosc. ;  In press 2008
  • 23 Pearl J P, Ponsky J L. Natural orifice transluminal endoscopic surgery: a critical review.  J Gastrointest Surg. ;  In press 2008
  • 24 Shibahara H, Shimada K, Kikuchi K. et al . Major complications and outcome of diagnostic and operative transvaginal hydrolaparoscopy.  J Obstet Gynaecol Res. 2007;  33 705-709
    CrossrefPubMedSearch in Google Scholar
  • 25 Chang W C, Hsu W C, Sheu B C. et al . Minimizing bladder injury in laparoscopically assisted vaginal hysterectomy among women with previous cesarean sections.  Surg Endosc. 2008;  22 171-176
    CrossrefPubMedSearch in Google Scholar
  • 26 Lane E. Culdoscopy – useful or useless?.  Int J Gynaecol Obstet. 1980;  17 372-374
    PubMedSearch in Google Scholar
  • 27 Heidenreich W. Sterilization by colpoceliotomy [in German].  Fortschr Med. 1983;  101 1855-1859
    PubMedSearch in Google Scholar
  • 28 Varadarajulu S, Tamhane A, Drelichman E R. Patient perception of natural orifice transluminal endoscopic surgery as a technique for cholecystectomy.  Gastrointest Endosc. 2008;  67 854-860
    CrossrefPubMedSearch in Google Scholar

C.-D. Heidecke, MD

Department of Surgery
Greifswald University Hospital
Ernst-Moritz-Arndt University of Greifswald

Friedrich-Loeffler-St. 23b
17475 Greifswald
Germany

Fax: +49-3834-866002

Email: heidecke@uni-greifswald.de