Natural Orifice Transluminal Endoscopic Surgery using the GelPOINT® V-Path Transvaginal Access Platform: An Early Experience

Objectives: Natural orifice transluminal endoscopic surgery (NOTES) is an endoscopic technique that involves the passage of an endoscope through a natural orifice (the mouth, vagina, and anus, among others). Although NOTES is used for gastroenterological operations and gynecologists are familiar with this approach, transvaginal NOTES (vNOTES) is not described for gynecological procedures. We report our early experience in nine patients who underwent vNOTES using the GelPOINT® V-Path device.Methods: We investigated nine patients who underwent vNOTES for pelvic organ prolapse and/or ovarian cysts between January and April 2020. Patients were placed in the lithotomy position under general anesthesia for the vNOTES procedure. We used the GelPOINT® V-Path platform, which included a GelSeal® cap, the Alexis retractor, and three sleeves. The patients were placed in a 15-degree Trendelenburg position under pneumoperitoneum of 8 mmHg.Results: The median operation time was 109 min (90–137 min), and the median estimated blood loss was 76 mL (50–150 mL). The vNOTES approach was useful to perform safe hysterectomy and/or salpingo-oophorectomy. Patients were discharged within 3 days postoperatively with minimal pain and no postoperative complications.Conclusion: This is the first report that describes vNOTES in Japan; therefore, the indications and surgical procedure have not yet been conclusively established. Further accumulation of cases with data regarding long-term outcomes is essential; however, in our opinion, vNOTES is a novel approach that could be useful in clinical practice.