Transvaginal salpingo-oophorectomy with gasless laparoscopy — an optional pure natural orifice transluminal endoscopic surgery

Objectives: To establish the appropriate technique for salpingo-oophorectomy via transvaginal natural orifice transluminalendoscopic surgery (NOTES), under gasless laparoscopy.Material and methods: Ten patients with clinical indication underwent gasless laparoscopic transvaginal salpingo-oophorectomywith concurrent vaginal hysterectomy. An abdominal-wall lifting device was used after removal of the uterus,and the adnexa was removed trans-vaginally by gasless laparoscopy. The perioperative clinical data, such as operativeduration, volume of blood loss, morbidity, intraoperative and postoperative complications, and length of hospital stay,were retrospectively analyzed.Results: All procedures were successfully done, without any intraoperative or major postoperative complications, and noadditional transabdominal ports were required. The salpingo-oophorectomy part of the procedure was completed in approximately11–40 minutes, with minimal blood loss. All of the patients were discharged, scar-free, 2–4 days after surgery.Conclusions: Transvaginal NOTES with gasless laparoscopy is a feasible and safe surgical technique in cases involving difficultvaginal salpingo-oophorectomy, which avoids conversion to an abdominal route