vNOTES for adnexal procedures.

This work aims to describe the technique and review all transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for adnexal procedures performed and to acknowledge vNOTES as an alternative to conventional laparoscopy. The procedure consisted of an incision in the Pouch of Douglas, insertion of a single port device, laparoscopic surgery through the device, extraction of specimens through the vagina and closure of the vaginal apex with a direct suture. Eighteen procedures have been successfully completed, 1 patient required conversion to conventional abdominal surgery due to intolerance to pneumoperitoneum. Surgeries' length range was 45-210 minutes. The estimated blood loss was less than 100 mL. The patients required minimal analgesia, were discharged the day after and had no postoperative complications. No patients complained of dyspareunia. Two patients conceived after surgery. vNOTES is a safe and desirable approach to the adnexa and a reasonable alternative to conventional laparoscopy or vaginal surgery.Impact statementWhat is already known on this subject? Natural Orifice Transluminal Surgery (NOTES) is a technique used to access the abdominal cavity through natural orifice. Compared to conventional laparoscopy, it's expected to have fewer complications.What do the results of this study add? This is one of the few works addressing vNOTES adnexal surgery, which appears to be a good alternative to conventional laparoscopy.What are the implications of these findings for clinical practice and/or further research? vNOTES may be a desirable approach to the adnexa. This work opens a door to new research regarding vNOTES in more complex gynaecologic procedures.

A case report of a rare disease: primary malignant melanoma of the esophagus

The case of 69 year-old caucasean woman with a primary malignant melanoma of the esophagus is described. She came to us with a 12-month history of digestive symptoms and was submitted to a near-total esophageal resection, followed by a cervical esophago-gastric anastomosis. The pathological study of the surgical specimen revealed an esophageal melanoma having foci of "junctional activity" involving the entire esophagus. The tumor invaded but did not extend beyond the muscularis propria. All lymph nodes were without metastases, but lymphatic invasion was present. Two courses of chemotherapy with DTIC, Cisplatinum, BCNU and Tamoxifen and later with Interferon and Carboplatin were tried. She died 2 years and 2 months after surgery.