AbstractThe purpose of this study was to demonstrate the feasibility and safety of adnexectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for benign adnexal masses. Conventional, reusable laparoscopic instru-ments were used, inserted through aninexpensive, self-constructed single port device. Between November 2013 and November 2014, 20 adnexectomies by vNOTES were per-formed by a single surgeon (BJ). Only conventional, reusable laparoscopic instruments were used. The self-constructed sin-gle port device was made by assembling a surgical glove, a wound protector, one reusable 10-mm trocar, and four reus-able 5-mm trocars. The adnexectomy was performed accord-ing to the technique for standard laparoscopic surgery, and the
specimen was removed through the colpotomy incision. Pa-tient and perioperative data were analysed. Twenty patient underwent adnexectomy by vNOTES, and no conversion to
standard laparoscopy or laparotomy was necessary. Mean op-eration time was 32min (20–50min); mean drop in hemoglo-bin level was 0.9 g/dl (0–2.1 g/dl). There were no operative complications. Post-operative pain scores were very low. The mean size of the removed adnexal mass was 51.8 mm (35– 110 mm). Adnexectomy by vNOTES is feasible even for masses up to 110 mm and even when performed with reus-able, conventional laparoscopic instruments. The main advan-tages of vNOTES are better cosmetics, low postoperative pain scores and easy removal of the specimen without spillage. This frugally innovative technique also enables surgeons to perform adnexectomies by vNOTES in low resource settings