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Complications of Transvaginal Natural Orifice Transluminal Endoscopic Surgery: A Series of 102 Patients

Wood, Stephanie G. MD; Panait, Lucian MD; Duffy, Andrew J. MD, FACS; Bell, Robert L. MD, FACS; Roberts, Kurt E. MD, FACS

Annals of Surgery:
doi: 10.1097/SLA.0b013e3182916138
Original Articles

Objective: To review the complications encountered in our facility and in previously published studies of transvaginal (TV) natural orifice transluminal endoscopic surgery (NOTES) to date.

Background: TV NOTES is currently observed with critical eyes from the surgical community, despite encouraging data to suggest improved short-term recovery and pain.

Methods: All TV NOTES procedures performed in female patients between 18 and 65 years of age were included. The median follow-up was 90 days. The TV appendectomies and ventral hernia repairs were pure NOTES, through a SILS port in the vagina, whereas TV cholecystectomies were hybrid procedures with the addition of a 5-mm port in the umbilicus.

Results: A total of 102 TV NOTES procedures, including 72 TV cholecystectomies, 24 TV appendectomies, and 6 TV ventral hernia repairs, were performed. The average age was 37 years old and body mass index was 29 kg/m2. Three major and 7 minor complications occurred. The first major complication was a rectal injury during a TV access port insertion. The second major complication was an omental vessel bleed after a TV cholecystectomy. The third complication was an intra-abdominal abscess after a TV appendectomy. Seven minor complications were urinary retention (4), transient brachial plexus injury, dislodgement of an intrauterine device, and vaginal granulation tissue.

Conclusions: As techniques in TV surgery are adopted, inevitably, complications may occur due to the inherent learning curve. Laparoscopic instruments, although adaptable to TV approaches, have yet to be optimized. A high index of suspicion is necessary to identify complications and optimize outcomes for patients.

In Brief

This study reviews complications in transvaginal natural orifice transluminal endoscopic surgery (NOTES). A total of 102 transvaginal NOTES procedures were performed in our institution, with an overall complication rate of 9.8%, including 3 major (in first 50 cases) and 7 minor complications. Our experience is representative of expected learning curve for adopting transvaginal NOTES.

Author Information

From the Department of Surgery, Yale School of Medicine, New Haven, CT.

Reprints: Kurt E. Roberts, MD, FACS, Department of Surgery, Yale School of Medicine, 40 Temple St, Suite 7B, New Haven, CT 06510. E-mail:

This study was presented as a Quick Shot presentation at the 7th Annual Meeting of the Academic Surgical Congress, Las Vegas NV, February 14–16, 2012.

Disclosure: Dr Kurt E. Roberts has intellectual property rights and ownership in NovaTract. For the remaining authors, there are no conflicts of interest or financial ties to disclose.

© 2014 by Lippincott Williams & Wilkins.