Two Cases of vNOTES Assisted Vaginal Adnexectomy in Management of Paraneoplastic Anti-N-Methyl-D-Aspartate Receptor Encephalitis Secondary to Ovarian Teratoma.

Anti-N-Methyl-D-Aspartate receptor encephalitis typically presents with neuropsychiatric symptoms, followed by autonomic dysregulation sometimes necessitating Intensive Care admission. It has a 15% mortality rate and when associated with ovarian teratoma, early surgical excision improves recovery rate by 25%. We describe the first two cases of vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) assisted vaginal adnexectomy for surgical treatment of ovarian teratoma associated anti-NMDA encephalitis and highlight the advantages of this novel approach. These include low insufflation pressures, shorter duration of surgery, avoidance of abdominal scarring, lower pain scores and more rapid recovery. While the outcomes in these two cases suggest that ovarian teratoma associated anti-NMDA encephalitis could be surgically managed through the vNOTES route rather than conventional laparoscopy, more randomized data still need to be available before this becomes standard approach.