Poor man's NOTES: can it be a good approach for adhesiolysis? A first case report with video demonstration.

Study Objective: To show that in selected cases transvaginal NOTES can be a frugally innovative approach for adhesiolysis and that it can be performed in a low-cost setting.
Design: Step-by-step explanation of the technique using videos and pictures (educative video).
Patients and Measurements: A 51-year old (para 2, gravida 2) presented with meso- and hypogastric pain. Two years before, an umbilical hernia had been repaired using a Proceed Ventral Patch mesh. The diagnosis of pain caused by adhesions was made, and laparoscopic adhesiolysis was planned. On ultrasound, a small left ovarian fibroma was visualized. Because of the suspected umbilical location of the adhesions, we decided to use a transvaginal NOTES approach to perform adhesiolysis and left adnexectomy. Pathological examination confirmed a small benign papillary serous adenofibroma of the ovary.
Interventions: A transvaginal NOTES approach to perform adhesiolysis combined with left adnexectomy using only standard reusable laparoscopic instruments and a low-cost self-constructed NOTES port.
Main Results: The procedure and postoperative recovery were uneventful. No minor or major complications occurred. The patient has been cured of her pain.
Conclusion: Transvaginal NOTES is a novel approach that requires further validation. This case report shows that transvaginal NOTES can be used to perform adhesiolysis for abdominal pain and that it can be performed in a low-cost setting without the need for expensive ports or disposable instruments.
(Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.)