Initial experience with transvaginal incisional hernia repair

Abstract

IntroductionNatural orifice surgery has evolved from a preclinical setting into a common occurrence at the University of California San Diego (UCSD). With close to 40 transvaginal cases, we have become comfortable with this technique and are exploring other indications. One of the perceived advantages in natural orifice surgery is the potential reduction in the incidence of hernia formation. Patients with abdominal wall hernias may be at increased risk of forming additional hernias at incision sites. In addition, patients with recurrent incisional hernias may, likewise, be at increased risk. We believe that reducing or eliminating abdominal wall incisions may be of benefit in the repair of abdominal wall hernias. Here, we describe what we believe to be the first natural orifice transluminal endoscopic surgical (NOTES) approach to the repair of an abdominal wall hernia.MethodsThe patient is a 38-year-old female with a painful recurrent umbilical hernia, previously repaired 8 years prior with a polypropylene-based mesh. The patient underwent a transvaginal recurrent umbilical hernia repair with one other 5-mm port in the abdomen for safety.ResultsThe patient had no intraoperative or postoperative complications. At 5 months follow up, the patient had no complaints, no evidence of hernia recurrence, and was very pleased with her result.ConclusionsThe repair of primary and incisional hernias of the ventral abdominal wall via a transvaginal approach is technically feasible, and the result of our initial case was exceptional. However, there are still significant obstacles which must be addressed before this approach can be widely utilized. These obstacles include safe entrance into the abdominal cavity via a transvaginal approach, the proper mesh to be placed during the repair, and the risk of infection.

Hybrid NOTES transvaginal intraperitoneal onlay mesh in abdominal wall hernias: an alternative to traditional laparoscopic procedures

“…We agree with other authors that a blind insertion of trocar transvaginally would be too uncertain or present unnecessary danger to the patient [5,13]. Safety has priority.…”

“…In 2009, Jacobsen et al [5] published the first case report of NOTES IPOM, followed by Bruna [6]. Last year, Wood published a small case series of six pure transvaginal ventral hernia repair procedures performed between November 2010 and February 2012 [7].…”

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (Notes): Surgical Technique and Results

“…That same year, several reports of cholecystectomy using this technique were published worldwide (Branco Filho et al, 2007;Dolz et al, 2007;Zorrón et al, 2007). Since then, this access has been used to perform several procedures, including nephrectomy (Branco et al, 2008b;Castillo et al, 2009;Kaouk et al, 2010;Ribal Caparrós et al, 2009), tubal sterilization (Kondo et al, 2009), liver resection (Noguera et al, 2008), sleeve gastrectomy (Fischer et al, 2009;Ramos et al, 2008b), adjustable gastric banding (Michalik et al, 2010), incisional hernia repair (Jacobsen et al, 2010), cancer diagnostic staging (Zorrón et al, 2008), splenectomy (Targarona et al, 2009), retroperitoneoscopy (Zorron et al, 2010a) among others. More recently, some case series have been published (Alcaraz et al, 2010;Asakuma et al, 2009;Cuadrado-Garcia et al, 2011;Hackethal et al, 2010;Horgan et al, 2009;Lehmann et al, 2010;Niu et al, 2010;Noguera et al, 2009;Noguera et al, 2010;Palanivelu et al, 2008;Pugliese et al, 2010;Ramos et al, 2008a;Sotelo et al, 2010;Zornig et al, 2010a;Zornig et al, 2010b;Zorron et al, 2010b).…”

NOTES for the management of an intra-abdominal abscess: transcolonic peritonoscopy and abscess drainage in a canine model

“…Patients seem to be early adopters of the technology, perhaps owing to a perception that surgical risk is related to incision size, whereas surgeons prefer to wait for more safety and efficacy outcome data. 32 Years after NOSCAR published the white paper on NOTES in 2005, and although various NOTES procedures have now been tested in humans, 25,26,[33][34][35][36] investigators continue to rely on animal models to better understand and overcome several of the barriers precluding NOTES from wide clinical adoption. In brief, we have shown the feasibility of transcolonic NOTES peritonoscopy and abscess drainage in a canine survival study.…”