Hybrid natural orifice transluminal endoscopic surgery splenectomy: A case report.

Laparoscopic splenectomy has become an established standard of care in managing surgical diseases of the normal-sized spleen. Natural orifice transluminal endoscopic surgery (NOTES) is a step forward in making laparoscopic surgery even less invasive. In addition, the spleen can be accessed easily with the hybrid transvaginal approach. We present the case of a 38-year-old woman with medical refractory immune thrombocytopenic purpura. Hybrid notes splenectomy was performed using three working 5-mm abdominal trocars and a 10-mm camera port through the posterior fornix of the vagina. The organ was retrieved intact transvaginally. The patient had minimal post-operative pain and was discharged on the 1st post-operative day. Transvaginal hybrid NOTES approach is feasible for operative visualisation, dissection, clipping and specimen extraction in patients requiring splenectomy. It may offer better cosmesis and faster recovery. Comparative studies with conventional laparoscopic approach are desirable.