NOTES

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Surgical Staging of Early-Stage Ovarian Cancers: A Report of Two Cases

https://tinyurl.com/y6tc5bum

 

         Modern surgical practice is developing to enable minimal access procedures. One technique becoming more common is called natural orifice transluminal endoscopic surgery (NOTES) where the abdominal cavity is accessed via the posterior fornix of the vagina with previous gaseous distension of the peritoneum allowing safe access to the pouch of Douglas. This is a potential space between the vagina and the rectum.

         Advantages of this technique include no visible scar and possibly no hernia complication. NOTES is being used for salpingectomy and management of cysts and endometriosis.

         This case report records the use of NOTES in early stage ovarian cancer. The procedure is combined with a transvaginal hysterectomy and enables removal of both ovaries and tubes together with biopsy of any suspicious lesion with removal of the peritoneal fold known as the lesser omentum. One of these patients was 81 years old and a low impact surgical approach was advantageous.