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World J Gastrointest Surg. Jun 27, 2010; 2(6): 179-186
Published online Jun 27, 2010. doi: 10.4240/wjgs.v2.i6.179
Natural orifice transluminal endoscopic surgery: The transvaginal route moving forward from cholecystectomy
Eduardo M Targarona, Edgar Mauricio Maldonado, Jose Antonio Marzol, Franco Marinello
Eduardo M Targarona, Edgar Mauricio Maldonado, Jose Antonio Marzol, Franco Marinello, Department of Surgery, Hospital Santpau, Autonomous University of Barcelona, Sant Quinti 89, 08041 Barcelona, Spain
Author contributions: Targarona EM conceived the idea, scripted and finally revised the manuscript; Maldonado EM, Marzol JA and Marinello F participated in reviewing the literature and writting the manuscript.
Correspondence to: Eduardo M Targarona, MD, Professor, Department of Surgery, Hospital Santpau, Autonomous University of Barcelona, Sant Quinti 89, 08041 Barcelona, Spain. etargarona@santpau.cat
Telephone: +34-93-5565671 Fax: +34-93-5565608
Received: December 26, 2009
Revised: February 1, 2010
Accepted: February 8, 2010
Published online: June 27, 2010
Abstract

The advent of minimally invasive surgery and the advances in endoluminal flexible endoscopy have converged to generate a new concept in digestive surgery, whose acronym natural orifice transluminal endoscopic surgery (NOTES), has become a familiar term in the surgical community. NOTES has been performed through the mouth, the bladder, the rectum and the vagina. Of these four approaches, the vagina has gained most popularity for several reasons. It is not only readily accessible and easy to decontaminate but it also provides safe entry and simple closure. The transvaginal approach has been described in the experimental and the clinical setting as an option for cholecystectomy, nephrectomy, splenectomy, segmental gastrectomy, retroperitoneal exploration and bariatric surgery. However, larger series are needed to delineate the exact risks of this approach, and to transcend cultural barriers that impede its wider introduction. Prospective randomized trials will shed light on the definitive role of the vaginal approach in minimal invasive surgery of the future.

Keywords: Transvaginal approach, Cholecystectomy, Nephrectomy, Splenectomy, Segmental gastrectomy, Retroperitoneal exploration, Natural orifice transluminal endoscopic surgery, Bariatric surgery