Analysis of the First 217 Appendectomies of the German NOTES Registry

OBJECTIVE:To analyze the feasibility and safety of Natural Orifice Transluminal Endoscopic Surgery (NOTES) appendectomy, and to analyze separately the transvaginal appendectomy (TVAE) and the transgastric appendectomy (TGAE) procedures. BACKGROUND:Laparoscopic appendectomy has rare but relevant complications, namely incisional hernias and neuralgia at the trocar sites, which can potentially be avoided by the NOTES techniques. METHODS:The first 217 data sets of the largest NOTES registry worldwide—the German NOTES registry—were analyzed with respect to demographic data, procedural data, and short-term outcomes. Furthermore, TVAEs were compared with TGAEs. RESULTS:Almost all procedures were performed in hybrid technique (median of percutaneous trocars1). Median age (TVAE30.5 yrs vs TGAE25 yrs; P = 0.017), body mass index (TVAE22.8 kg/m vs TGAE24.1 kg/m; P = 0.016), and American Society of (ASA) classification (I/II/III; TVAE57.1%/41.8%/1.0% vs TGAE27.8%/69.4%/2.8%; P = 0.003) significantly differed between both access techniques. Whereas the median number of percutaneous trocars (TVAE1 vs TGAE1; P = 0.450), the need of additional trocars (TVAE6.6% vs TGAE13.9%; P = 0.156), the intra, and also postoperative rate of complications (TVAE0%/5.5% vs TGAE0%/11.1%; P = 1.000/0.258), and the median postoperative hospital stay (TVAE3 d vs TGAE3 d; P = 0.152) were comparable; the median procedural time (TVAE35 minutes vs TGAE96 minutes; P < 0.001) and conversion to laparotomy rate (TVAE0% vs TGAE5.6%; P = 0.023) were significantly less after TVAE. CONCLUSIONS:The evaluation of the largest patient collective so far indicates that hybrid NOTES appendectomy is a safe procedure, with advantages for the transvaginal technique with respect to procedural time and conversion rate.