Natural orifice transluminal endoscopic surgery (NOTES) salpingectomy for ectopic pregnancy: a first series demonstrating how a new surgical technique can be applied in a low-resource setting

摘要

This paper demonstrates the feasibility of a salpingectomy for ectopic pregnancy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Conventional, reusable laparoscopic instruments were used and inserted through an inexpensive, self-constructed single port device. The self-constructed single port device was made by assembling a surgical glove, a wound protector, one reusable 10-mm trocar and four reusable 5-mm trocars. We report on five patients who underwent a vNOTES salpingectomy between September 2014 and February 2015. All procedures were successfully performed, without conversion to multi-incision laparoscopy or laparotomy. This demonstrates that it is possible to perform a vNOTES salpingectomy without any financial investment in expensive ports, disposable instruments or sealing devices (Video 1). Patient and perioperative data were analysed (Table 1). NOTES salpingectomy is a novel technique requiring further validation. It could be a less invasive alternative to a laparoscopic salpingectomy. A better cosmetic result, by avoiding abdominal incision scars, and less port-related complications, can be expected. Keywords Transvaginal natural orifice transluminal endoscopic surgery (NOTES) Single port Frugal innovation Tubal pregnancy Salpingectomy Low resource vNOTES.