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Natural Orifice Transluminal Endoscopic Surgery (NOTES)

As a healthcare provider, you’ve likely worked with patients who are considering some form of surgery. Whether it’s a routine appendectomy or an unexpected mastectomy, the anticipation of a hospital stay, anesthesia, and complicated incisions can make anyone nervous.

This can be especially true if the type of surgery is relatively new. Today we’re going to talk a bit about natural orifice transluminal endoscopic surgery (NOTES), a technique that has been developed in the past decade or so. More specifically, we’ll look at a study that examines transvaginal organ extraction using NOTES and how it affects women.

What is NOTES?

NOTES involves conducting surgery through a natural orifice – a natural opening in the body - such as the mouth or the vagina. NOTES is getting more attention lately for it use in cholecystectomy (gallbladder removal), appendectomies, and sleeve gastrectomies (weight-loss surgery that removes part of the stomach).

Some of the advantages of NOTES include less scarring, reduced chances for infection, and decreased recovery time compared to more traditional surgery. Some patients also report less pain.

However, women considering NOTES through the vagina may be concerned about how such a procedure might affect sexual function and childbirth.

Researchers from the Center for the Future of Surgery at the UC San Diego School of Medicine examined this issue and presented their findings at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, held in Baltimore in April 2013.

How might NOTES affect women?

The research team analyzed data from 34 women who ranged in age from 23 to 63 (with a mean age of 40 years) and had undergone NOTES. Their surgeons had used a hybrid natural orifice approach that involved conventional laparoscopic surgery with transvaginal organ extraction at the end of the operation. The surgeries included cholecystectomy, appendectomy, and sleeve gastrectomy.

The researchers found that:

  • None of the surgeries had to be converted to open operations.
  • There were no intraoperative complications.
  • The mean hospital stay for all the women was 2 days.

The patients were followed for a mean of 24 months. In that time, there were no long-term complications. Six of the women had some spotting or heavy menstrual periods shortly after the surgery, but these issues were taken care of conservatively.

Two pregnancies and two successful vaginal deliveries also occurred during this time period.

The study authors concluded, “This initial experience suggests that this surgical approach is safe, does not increase length of stay, and has no long-term vaginal complications.”

What’s next?

More research is needed to further evaluate NOTES and provide long-term follow up. However, this study may put some of your female patients at ease, if they are considering transvaginal organ extraction. Of course, their surgeon can best address their specific concerns.


General Surgery News

Smith, Monica J.

“In Study, Transvaginal NOTES Causes No Sexual Dysfunction”

(September 2013)

Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

Barajas-Gamboa, Juan S., MD, et al.

“Trans-Vaginal Organ Extraction: Potential for Broad Clinical Application”

(Abstract S104. Presented at SAGES 2013, April 17-20, 2013, Baltimore, MD)

Yale School of Medicine

“Scarless Surgery”

(WTNH – New Haven, Connecticut - video broadcast on December 24, 2009. No longer available on or Accessed via Yale School of Medicine website.)

“Scarless Surgery/NOTES”