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Results of clinical applications of NOTES in the IMTN Study showed the feasibility of different methods of this new minimally invasive alternative for laparoscopic and open surgery.

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So far in humans, transgastric appendectomy and cholecystectomy, and transvaginal cholecystectomy have been reported. A transvaginal endoscopic appendectomy in humans has not been reported yet. The transvaginal approach provided a normal image of the target organ, unlike the inverted image of a transgastric approach caused by the inability to manipulate the scope outside the mouth. The technical ease of the procedure and early outcome seem satisfactory, although comparative studies are needed to confirm this.

Since the first description of NOTES, there has been no standardized technique. In our technique, we used a single 3-mm trocar for visualizing the entry and exit of the endoscope, maintaining and measuring pneumoperitoneum, and retracting the gall bladder fundus. The instruments that were used were the conventional endoscopic ones. The transvaginal approach seems to be a viable alternative to the transgastric approach for cholecystectomy, as the transgastric approach has certain inherent problems like leakage from the gastrotomy site and poor ergonomy. The downside to the transvaginal approach is that it is possible only in women.