Alternative method for the diagnosis of acid cases of unknown cause: Transvaginal natural orifice transluminal endoscopic surgery

Abstract

Aim To evaluate the efficacy and reliability of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) technique in making the diagnosis of ascites with unknown cause. Methods Seven patients with ascites with unknown cause and diagnosed with vNOTES between November 2018 and May 2019 were analyzed retrospectively. The following data were collected retrospectively: body mass index, age, parity, previous abdominal or pelvic surgery, total operating time, perioperative complications and visual analog scale scores for evaluation of postoperative pain. After general anesthesia and disinfection, a 2–3 cm incision was made in the posterior fornix of the vagina. In all of the vNOTES procedures, a handmade glove port system comprised of a glove‐wound retractor NOTES port was used. Results Transvaginal natural orifice transluminal endoscopic surgery for diagnostic peritoneoscopy was successfully performed in seven patients. Following postoperative pathological examination; three patients were established to have peritoneal carcinomatosis, one patient abdominal tuberculous, one patient ovarian fibroma, one patient ovarian mature cystic teratoma and one patient stomach cancer. In 1‐year follow‐up period after vNOTES procedure, no adverse events occurred in patients. Conclusion In making histological diagnosis of ascites with unknown cause, vNOTES is a feasible, safe and efficient technique. Due to its high performance in diagnosis, this technique helps to initiate treatment early in some diseases in addition to preventing unnecessary treatment and examination in benign diseases. Besides, via obtaining a detailed and enlarged image of abdominal cavity, this procedure also guides the clinician in the evaluation of the suitability of patient for operation.

A New and Alternative Route: Transvaginal Natural Orifice Transluminal Endoscopic Scarless Surgery (vaginal natural orifice transluminal endoscopic surgery) For Class 2 and Class 3 Obese Patients Suffering From Benign and Malignant Gynecologic Pathologies

“…We found that vNOTES is a feasible, safe, and efficient technique in obese and non-obese patients which helps to initiate treatment early in some diseases in addition to preventing unnecessary treatment and examination in benign diseases. 9,15 In the present study, we diagnosed peritoneal carcinomatosis in three obese patients with ascites of unknown cause using the vNOTES technique and showed that this technique can be used for alternative diagnosis of ascites of unknown cause Several studies have also demonstrated that vNOTES can be performed successfully and safely in a series of benign gynecologic surgeries. Ahn et al 16 reported that mean operation time was 67.5 minutes in their patients who underwent vNOTES operations for benign reasons.…”

“…We found that vNOTES is a feasible, safe, and efficient technique in obese and non-obese patients which helps to initiate treatment early in some diseases in addition to preventing unnecessary treatment and examination in benign diseases. 9,15 In the present study, we diagnosed peritoneal carcinomatosis in three obese patients with ascites of unknown cause using the vNOTES technique and showed that this technique can be used for alternative diagnosis of ascites of unknown cause…”

Comparison of hysterectomy cases performed by transvaginal natural orifice transluminal endoscopic surgery: A paired sample cross-sectional study

“…Mat et al observed that v-NOTES can not only be used for the diagnosis and treatment of benign obese cases, [ 29 ] but also provides greater benefits for patients with early endometrial cancer and severe obesity (mean body mass index of 51.4 kg/m²) [ 30 ] or unexplained ascites. [ 31 ] In recent years, a study has shown that the success of v-NOTES in adnexectomy has significantly increased the utilization rate of v-NOTES for hysterectomy (94.3%) and the accompanying BSO rate (6.8% vs 75%). [ 32 ] This also allows us to use it in challenging cases, such as transgender men and patients with ovarian cysts or ectopic pregnancy.…”