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NOTES-Assisted Transvaginal Splenectomy: The Next Step in the Minimally Invasive Approach to the Spleen

Service of Surgery, Hospital de Sant Pau, UAB, Barcelona, Spain, 13882ets{at}comb.es

Cristina Gomez, MD, PhD

Endoscopy Unit, Hospital de Sant Pau, UAB, Barcelona, Spain

Ramon Rovira, MD

Service of Gynecology, Hospital de Sant Pau, UAB, Barcelona, Spain

Juan Carlos Pernas, MD

Service of Radiology, Hospital de Sant Pau, UAB, Barcelona, Spain

Carmen Balague, MD, PhD

Service of Surgery, Hospital de Sant Pau, UAB, Barcelona, Spain

Carlos Guarner-Argente, MD

Endoscopy Unit, Hospital de Sant Pau, UAB, Barcelona, Spain

Sergio Sainz, MD

Endoscopy Unit, Hospital de Sant Pau, UAB, Barcelona, Spain

Manuel Trias, MD, PhD

Service of Surgery, Hospital de Sant Pau, UAB, Barcelona, Spain

Hypothesis. Natural orifice transluminal endoscopic surgery (NOTES) has marked yet another step forward in less-invasive surgical procedures. Access to solid organs located deep in the left hypochondrium can be difficult using this technique but the transvaginal approach with the patient positioned in full lateral decubitus may be an option. Material and methods. We present the case of a 60-year-old woman with a symptomatic splenic polycystic tumor. The procedure was carried out by a multidisciplinary team using a standard flexible videogastroscope and endoscopic instruments. Transvaginal visualization of the spleen and standard dissection of attachments were feasible, and splenectomy was completed using transvaginal stapling of the splenic hilum. The organ was extracted transvaginally. Results. The postoperative course was uneventful. The patient had minimal postoperative pain and minimal scars, and was discharged on the second postoperative day. Conclusions. Transvaginal access can be safely used for operative visualization, hilum transection, and spleen removal with conventional instrumentation, reducing parietal wall trauma to a minimum. The clinical, esthetic, and functional advantages require further analysis.

Key Words: spleen • NOTES • transvaginal • endoscopic surgery

This version was published on September 1, 2009

Surgical Innovation, Vol. 16, No. 3, 218-222 (2009)
DOI: 10.1177/1553350609345488


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