Hybrid vaginal MA-NOS sleeve gastrectomy: technical note on the procedure in a patient

Abstract

Transvaginal hybrid MA-NOS sleeve gastrectomy is both feasible and safe. The hybrid technique ensured safety during the performance of the procedure. MA-NOS is a potential option to avoid abdominal incisions and related complications for the laparoscopic resection of large intra-abdominal organs. Combined hybrid laparoscopic NOS for humans is currently a safe and reliable approach for major surgery through the NOS approach in female patients. Hybrid surgery allows controlled implementation of NOS techniques in clinical practice, providing a stepwise progression to the pure NOS approach once the appropriate technology has been developed. Additionally, it is the best way to stimulate the active development and evaluation of the underpinning technologies and instruments for these novel endoscopic surgical approaches. Appropriate clinical indications for these new procedures are yet to be defined. LSG is associated with short-term excess weight loss and resolution of comorbidities comparable to those obtained with other restrictive procedures. The performance of sleeve gastrectomy is an option in selected patients undergoing bariatric surgical treatment, particularly in the super obese and those who are considered high risk because of comorbid disease.

NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance

“…Marescaux [3]. Since then, transvaginal access has become the preferred route for NOTES procedures with the international experience now numbering several hundred cases performed, including cholecystectomy, nephrectomy, sleeve gastrectomy, and segmental colon resection [4][5][6][7][8][9]. The major limitation of the approach is that it can only be performed in women.…”

Natural orifice translumenal endoscopic surgery (NOTES®): a technical review

“…We also found 12 articles describing cases limited to natural orifice specimen extraction (NOSE) and/or visualization through the natural orifice, cases in which the lumen was not traversed, and cases which considered the umbilicus a natural orifice. These 12 articles [3,15,17,26,28,33,36,39,41,43,44,46] were excluded from the final analysis as they were not felt to adequately meet the definition of NOTES. Thus, 43 articles [4, 5, 7-9, 11, 12, 14, 18-25, 27, 29-32, 35, 37, 38, 40, 42, 45, 47-56, 59, 61-65] were included in the final analysis after accounting for articles reporting redundant sets of patients and those failing to adequately meet the definition of NOTES.…”

Minilaparoscopy-assisted natural orifice total colectomy: technical report of a minilaparoscopy-assisted transrectal resection

“…More than 2,500 advanced minimally invasive colorectal resections have been performed at this institution (unpublished data). Efforts to develop NOTES approaches led us to the first clinical reports of MA-NOS transvaginal radical sigmoid resection in 2008, MA-NOS transvaginal sleeve gastrectomy in 2009, and NOTES transanal rectal cancer resection in 2010 [3,4,7]. Each procedure was monitored by the Institutional Review Board and the Ethical Committee of the Hospital Clínic.…”

“…As pioneers in the performance of these approaches, our group, after extensive experimental experience in NOTES, published the first clinical transvaginal hybrid sigmoid resection (minilaparoscopy-assisted natural orifice surgery [MA-NOS]) and sleeve gastrectomy performed in a human [3,4].…”