V11-11: Pure transvaginal natural orifice transluminal endoscopic surgery (NOTES) nephrectomy (video)
Pure natural orifice translumenal endoscopic surgery (NOTES) in urology has largely been limited to experimental animal studies. We describe the initial clinical experience of pure transvaginal NOTES nephrectomy in our center.
A female patients with age of 50 years old with right non-function kidney and a median body mass index of 23.8kg/m2, was subjected to pure transvaginal NOTES nephrectomy in our center. After induction of general anesthesia, the patient was positioned in lithotomy with ipsilateral lumbar at 60° angle to the floor. A 5-mm incision was made at the posterior vaginal fornix, and a 5-mm trocar was introduced into the pelvic cavity guided by a 5-mm forceps. A 5.4-mm flexible-tip 0° laparoscope was inserted into the pelvic cavity confirming no rectum injury. Then a ZOU-port or TriPort was introduced at the posterior vaginal fornix. Dissection was performed according to the method of the standard laparoscopic nephrectomy and renal cyst excision. The intact specimen was extracted transvaginally.
The procedure was successfully completed without additional trocars. There was no other major perioperative complication occurred. The operative time was 172min, and estimated blood loss was 190ml. The visual analog pain scale score was 2. The patient resumed ambulation on postoperative day 2 d. The pelvic drainage was removed on postoperative day 2d. The patient resumed nutrition on postoperative day 2d. Follow-up of 4 to 12 month showed that the incision in the vagina healed well and no experienced sexual dysfunction.
Pure transvaginal NOTES for nephrectomy is feasible and effective. It provides a good cosmetic outcome with less pain.