Systematic Review and Meta-analysis of Complications in Transvaginal Approach in Laparoscopic Surgery.

Transvaginal access is the most popular natural orifice translumenal technique in the minimally invasive surgery. Reviews on non-gynecological transvaginal approach morbidities reveal that rates vary greatly. A systematic review of transvaginal approach in non-gynecological intraabdominal procedures was carried out to assess the risk of complications. A systematic search was conducted using MEDLINE, EMBASE, PubMed, and the Cochrane Library from the inception of these databases to March 2012. The following keywords were searched: “transvaginal”, “NOTES”, “single incision”, and “single port”. From the total of 231 potentially eligible abstracts, 87 papers were retrieved and evaluated as fulfilling the eligibility criteria. The final analysis included 32 articles. The overall complications rate was 4.4 %, and complications related to the transvaginal port reached 2.4 %. Conversion rate to open surgery was 3.4 %. The incidence of postoperative urinary tract infection was 0.8 %. The mean operative time was 119 min. The mean hospital stay was 3.1 days (range 6 h–12 days). The technique of transvaginal access can offer several advantages for a patient and is associated with an acceptable rate of complications. Similar content being viewed by others

Hackethal A, Sucke J, Oehmke F, Munstedt K, Padberg W, Tinneberg HR (2010) Establishing transvaginal NOTES for gynecological and surgical indications: benefits, limits, and patient experience. Endoscopy 42(10):875–878. doi:10.1055/s-0030-1255756 Bucher P, Pugin F, Morel P (2009) Single-port access laparoscopic radical left colectomy in humans. Dis Colon Rectum 52(10):1797–1801. doi:10.1007/DCR.0b013e3181b551ce DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188 (2009) Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2. http:// www.cochrane-handbook.org [updated September 2009]. The Cochrane Collaboration Abrao MS, Sagae UE, Gonzales M, Podgaec S, Dias JA Jr (2005) Treatment of rectosigmoid endometriosis by laparoscopically assisted vaginal rectosigmoidectomy. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet 91(1):27–31. doi:10.1016/j.ijgo.2005.06.014 Alcaraz A, Musquera M, Peri L, Izquierdo L, Garcia-Cruz E, Huguet J, Alvarez-Vijande R, Campistol JM, Oppenheimer F, Ribal MJ (2011) Feasibility of transvaginal natural orifice transluminal endoscopic surgery-assisted living donor nephrectomy: is kidney vaginal delivery the approach of the future? Eur Urol 59(6):1019–1025. doi:10.1016/j.eururo.2011.03.021 Alcaraz A, Peri L, Molina A, Goicoechea I, Garcia E, Izquierdo L, Ribal MJ (2010) Feasibility of transvaginal NOTES-assisted laparoscopic nephrectomy. Eur Urol 57(2):233–237. doi:10.1016/j.eururo.2009.09.025 Asakuma M, Perretta S, Allemann P, Cahill R, Con SA, Solano C, Pasupathy S, Mutter D, Dallemagne B, Marescaux J (2009) Challenges and lessons learned from NOTES cholecystectomy initial experience: a stepwise approach from the laboratory to clinical application. J Hepato Biliary Pancreat Surg 16(3):249–254. doi:10.1007/s00534-009-0089-3 Buesing M, Utech M, Halter J, Riege R, Saada G, Knapp A (2011) Sleeve gastrectomy in the treatment of morbid obesity. Study results and first experiences with the transvaginal hybrid NOTES technique. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 82(8):675–683. doi:10.1007/s00104-010-1990-7 Castro-Perez R, Acosta-Gonzalez LR, Dopico-Reyes E, Robaina-Arias LE (2009) MANOS: Transvaginal cholecystectomies: preliminary report. Cir Esp 85(5):292–297. doi:10.1016/j.ciresp.2009.01.005 Cuadrado-Garcia A, Noguera JF, Olea-Martinez JM, Morales R, Dolz C, Lozano L, Vicens JC, Pujol JJ (2011) Hybrid natural orifice transluminal endoscopic cholecystectomy: prospective human series. Surg Endosc 25(1):19–22. doi:10.1007/s00464-010-1121-z Decarli LA, Zorron R, Branco A, Lima FC, Tang M, Pioneer SR, Sanseverino JI, Menguer R, Bigolin AV, Gagner M (2009) New hybrid approach for NOTES transvaginal cholecystectomy: preliminary clinical experience. Surg innov 16(2):181–186. doi:10.1177/1553350609339375 Ghezzi F, Cromi A, Ciravolo G, Rampinelli F, Braga M, Boni L (2008) A new laparoscopic-transvaginal technique for rectosigmoid resection in patients with endometriosis. Fertil Steril 90(5):1964–1968. doi:10.1016/j.fertnstert.2007.09.002 Hensel M, Schernikau U, Schmidt A, Arlt G (2011) Surgical outcome and midterm follow-up after transvaginal NOTES hybrid cholecystectomy: analysis of a prospective clinical series. J Laparoendosc Adv surg C Part A 21(2):101–106. doi:10.1089/lap.2010.0508 Horgan S, Cullen JP, Talamini MA, Mintz Y, Ferreres A, Jacobsen GR, Sandler B, Bosia J, Savides T, Easter DW, Savu MK, Ramamoorthy SL, Whitcomb E, Agarwal S, Lukacz E, Dominguez G, Ferraina P (2009) Natural orifice surgery: initial clinical experience. Surg Endosc 23(7):1512–1518. doi:10.1007/s00464-009-0428-0 Jerby BL, Kessler H, Falcone T, Milsom JW (1999) Laparoscopic management of colorectal endometriosis. Surg Endosc 13(11):1125–1128 Lehmann KS, Ritz JP, Wibmer A, Gellert K, Zornig C, Burghardt J, Busing M, Runkel N, Kohlhaw K, Albrecht R, Kirchner TG, Arlt G, Mall JW, Butters M, Bulian DR, Bretschneider J, Holmer C, Buhr HJ (2010) The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Annals Surg 252(2):263–270. doi:10.1097/SLA.0b013e3181e6240f Linke GR, Tarantino I, Hoetzel R, Warschkow R, Lange J, Lachat R, Zerz A (2010) Transvaginal rigid-hybrid NOTES cholecystectomy: evaluation in routine clinical practice. Endoscopy 42(7):571–575. doi:10.1055/s-0029-1244159 Navarra G, Rando L, La Malfa G, Bartolotta G, Pracanica G (2009) Hybrid transvaginal cholecystectomy: a novel approach. Am J Surg 197(6):e69–e72. doi:10.1016/j.amjsurg.2008.07.059 Niu J, Song W, Yan M, Fan W, Niu W, Liu E, Peng C, Lin P, Li P, Khan AQ (2011) Transvaginal laparoscopically assisted endoscopic cholecystectomy: preliminary clinical results for a series of 43 cases in China. Surg Endosc 25(4):1281–1286. doi:10.1007/s00464-010-1360-z Noguera J, Dolz C, Cuadrado A, Olea J, Vilella A, Morales R (2009) Hybrid transvaginal cholecystectomy, NOTES, and minilaparoscopy: analysis of a prospective clinical series. Surg Endosc 23(4):876–881. doi:10.1007/s00464-008-0288-z Noguera JF, Cuadrado A, Sanchez-Margallo FM, Dolz C, Asencio JM, Olea JM, Morales R, Lozano L, Vicens JC (2011) Emergency transvaginal hybrid natural orifice transluminal endoscopic surgery. Endoscopy 43(5):442–444. doi:10.1055/s-0030-1256042 Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Prasad M (2008) Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES—world's first report. Surg Endosc 22(5):1343–1347. doi:10.1007/s00464-008-9811-5 Palanivelu C, Rajan PS, Rangarajan M, Prasad M, Kalyanakumari V, Parthasarathi R, Senthilnathan P (2009) NOTES: Transvaginal endoscopic cholecystectomy in humans-preliminary report of a case series. Am J Gastroenterol 104(4):843–847. doi:10.1038/ajg.2009.1 Park JS, Choi GS, Kim HJ, Park SY, Jun SH (2011) Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy. Br J Surg 98(5):710–715. doi:10.1002/bjs.7419 Porpiglia F, Fiori C, Morra I, Scarpa RM (2011) Transvaginal natural orifice transluminal endoscopic surgery-assisted minilaparoscopic nephrectomy: a step towards scarless surgery. Eur Urol 60(4):862–866. doi:10.1016/j.eururo.2010.09.038 Pugliese R, Forgione A, Sansonna F, Ferrari GC, Di Lernia S, Magistro C (2010) Hybrid NOTES transvaginal cholecystectomy: operative and long-term results after 18 cases. Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie 395(3):241–245. doi:10.1007/s00423-009-0528-2 Ramos AC, Murakami A, Galvao Neto M, Galvao MS, Silva AC, Canseco EG, Moyses Y (2008) NOTES transvaginal video-assisted cholecystectomy: first series. Endoscopy 40(7):572–575. doi:10.1055/s-2008-1077398 Redwine DB, Koning M, Sharpe DR (1996) Laparoscopically assisted transvaginal segmental resection of the rectosigmoid colon for endometriosis. Fertil Steril 65(1):193–197 Roberts KE, Shetty S, Shariff AH, Silasi DA, Duffy AJ, Bell RL (2012) Transvaginal NOTES hybrid cholecystectomy. Surg Innov 19(3):230–235. doi:10.1177/1553350611427547 Salinas G, Saavedra L, Agurto H, Quispe R, Ramirez E, Grande J, Tamayo J, Sanchez V, Malaga D, Marks JM (2010) Early experience in human hybrid transgastric and transvaginal endoscopic cholecystectomy. Surg Endosc 24(5):1092–1098. doi:10.1007/s00464-009-0733-7 Solomon D, Lentz R, Duffy AJ, Bell RL, Roberts KE (2012) Female sexual function after pure transvaginal appendectomy: a cohort study. J Gastrointest Surg : Off J Soc Surg Aliment Tract 16(1):183–186. doi:10.1007/s11605-011-1706-4, discussion 186-187 Tarantino I, Linke GR, Lange J, Siercks I, Warschkow R, Zerz A (2011) Transvaginal rigid-hybrid natural orifice transluminal endoscopic surgery technique for anterior resection treatment of diverticulitis: a feasibility study. Surg Endosc 25(9):3034–3042. doi:10.1007/s00464-011-1666-5 Zorron R, Palanivelu C, Galvao Neto MP, Ramos A, Salinas G, Burghardt J, DeCarli L, Henrique Sousa L, Forgione A, Pugliese R, Branco AJ, Balashanmugan TS, Boza C, Corcione F, D'Avila Avila F, Arturo Gomez N, Galvao Ribeiro PA, Martins S, Filgueiras M, Gellert K, Wood Branco A, Kondo W, Inacio Sanseverino J, de Sousa JA, Saavedra L, Ramirez E, Campos J, Sivakumar K, Rajan PS, Jategaonkar PA, Ranagrajan M, Parthasarathi R, Senthilnathan P, Prasad M, Cuccurullo D, Muller V (2010) International multicenter trial on clinical natural orifice surgery—NOTES IMTN study: preliminary results of 362 patients. Surg innov 17(2):142–158. doi:10.1177/1553350610370968 Zou X, Zhang G, Xiao R, Yuan Y, Wu G, Wang X, Long D, Wu Y, Liu M, Xue Y, Zhang X (2011) Transvaginal natural orifice transluminal endoscopic surgery (NOTES)-assisted laparoscopic adrenalectomy: first clinical experience. Surg Endosc 25(12):3767–3772. doi:10.1007/s00464-011-1786-y Linke GR, Luz S, Janczak J, Zerz A, Schmied BM, Siercks I, Warschkow R, Beutner U, Tarantino I (2013) Evaluation of sexual function in sexually active women 1 year after transvaginal NOTES: a prospective cohort study of 106 patients. Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie 398(1):139–145. doi:10.1007/s00423-012-0993-x Alba Mesa F, Amaya Cortijo A, Romero Fernandez JM, Komorowski AL, Sanchez Hurtado MA, Fernandez Ortega E, Sanchez Margallo FM (2012) Transvaginal sigmoid cancer resection: first case with 12 months of follow-up–technique description. J Laparoendosc Adv Surg Tech Part A 22(6):587–590. doi:10.1089/lap.2011.0469 Navarra G, La Malfa G, Lazzara S, Ullo G, Curro G (2010) SILS and NOTES cholecystectomy: a tailored approach. J Laparoendosc Adv Surg Tech Part A 20(6):511–514. doi:10.1089/lap.2010.0228 Mofid H, Emmermann A, Alm M, Zornig C (2013) Transvaginal specimen removal after laparoscopic distal pancreatic resection. Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie 398(7):1001–1005. doi:10.1007/s00423-013-1092-3 Truong T, Arnaoutakis D, Awad ZT (2012) Laparoscopic hybrid NOTES liver resection for metastatic colorectal cancer. Surg Laparosc, Endosc Percutaneous Tech 22(1):e5–e7. doi:10.1097/SLE.0b013e31823f7596 Diana M, Perretta S, Wall J, Costantino FA, Leroy J, Demartines N, Marescaux J (2011) Transvaginal specimen extraction in colorectal surgery: current state of the art. Color Dis Off J Assoc Coloproctology Great Britain Ireland 13(6):e104–e111. doi:10.1111/j.1463-1318.2011.02599.x Wood SG, Panait L, Duffy AJ, Bell RL, Roberts KE (2013) Complications of Transvaginal Natural Orifice Transluminal Endoscopic Surgery: a series of 102 patients. Ann Surg. doi:10.1097/SLA.0b013e3182916138 Trastulli S, Cirocchi R, Desiderio J, Guarino S, Santoro A, Parisi A, Noya G, Boselli C (2013) Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic cholecystectomy. Brit J Surg 100(2):191–208. doi:10.1002/bjs.8937 Brehm V, Steenvoorde P, Oskam J (2008) Vaginal evisceration of small-bowel loops following prior vaginal hysterectomy: a graciloplasty performed to reconstruct the rectovaginal septum. Int J Surg (London, England) 6(6):e34–e35. doi:10.1016/j.ijsu.2006.11.004 Conflict of interest statement None declared. Funding sources and/or financial interests None declared. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Komorowski, A.L., Alba Mesa, F., Bała, M.M. et al. Systematic Review and Meta-analysis of Complications in Transvaginal Approach in Laparoscopic Surgery. Indian J Surg 77 (Suppl 3), 853–862 (2015). https://doi.org/10.1007/s12262-014-1038-1 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s12262-014-1038-1