{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T10:35:12Z","timestamp":1761129312354,"version":"3.41.0"},"reference-count":25,"publisher":"International College of Surgeons","issue":"3-4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:p>This paper represents an evaluation of a hybrid approach to natural orifice transluminal endoscopic surgery (NOTES) and its performance relative to conventional procedures. Globally, numerous institutions have successfully implemented minimally invasive surgeries by applying NOTES techniques and achieved decreased morbidity while performing incision-less surgery. However, these techniques are still not common in surgical practice in China and Pakistan. Documenting the experiences and challenges encountered in implementing NOTES in such environments can provide guidance for NOTES implementation elsewhere. From May 2010 to April 2012, 16 human transvaginal appendectomies were carried out applying a hybrid NOTES technique using a solo-umbilical trocar, which provided a safe access for laparoscopic assistance during surgical procedure. After removal of the appendix transvaginally, the colpotomy was sutured under direct vision with absorbable stitches. The outcomes of cases treated with hybrid NOTES techniques were compared to those of conventional laparoscopic appendectomy. All patients underwent a successful surgical procedure with no intra- or postoperative complications and provided no specific complaints during the 10th day and a monthly follow-up for 2 years. The patients convalesced promptly with healthy and satisfactory cosmetic results. Compared to conventional laparoscopic appendectomy, the hybrid NOTES operation had less postoperative pain, lower cost, and shorter hospitalization. Hybrid NOTES procedures can be performed safely using a solo-umbilical trocar. Our initial experience reveals that this hybrid technique is practically feasible and associated with minimal postoperative pain, reasonable convalescence time, and improved cosmetic outcomes.<\/jats:p>","DOI":"10.9738\/intsurg-d-16-00003.1","type":"journal-article","created":{"date-parts":[[2016,3,21]],"date-time":"2016-03-21T13:28:08Z","timestamp":1458566888000},"page":"153-160","source":"Crossref","is-referenced-by-count":5,"title":["Transvaginal Laparoscopically-Assisted Endoscopic Appendectomy: A Major Hybrid Natural Orifice Transluminal Endoscopic Surgery Case Series in Asia"],"prefix":"10.9738","volume":"101","author":[{"given":"Abdul Qadir","family":"Khan","sequence":"first","affiliation":[{"name":"Institute of Laparoscopic Minimally Invasive Surgery, Qilu Hospital of Shandong University, Shandong, China"},{"name":"Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Shandong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enyu","family":"Liu","sequence":"additional","affiliation":[{"name":"Institute of Laparoscopic Minimally Invasive Surgery, Qilu Hospital of Shandong University, Shandong, China"},{"name":"Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Shandong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weibo","family":"Niu","sequence":"additional","affiliation":[{"name":"Institute of Laparoscopic Minimally Invasive Surgery, Qilu Hospital of Shandong University, Shandong, China"},{"name":"Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Shandong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Shandong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hazrat","family":"Gul","sequence":"additional","affiliation":[{"name":"Department of Surgery, Lady Reading Hospital, Peshawar, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Fokeerchand","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanchang University, Jiangxi, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Niu","sequence":"additional","affiliation":[{"name":"Institute of Laparoscopic Minimally Invasive Surgery, Qilu Hospital of Shandong University, Shandong, China"},{"name":"Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Shandong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4721","reference":[{"issue":"3","key":"i0020-8868-101-3-153-b01","series-title":"Urology","first-page":"446","article-title":"Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model","volume":"59","author":"Gettman \n              MT,","year":"2002","unstructured":"Gettman \n              MT, \n            \n            \n              Lotan \n              Y, \n            \n            \n              Napper \n              CA, \n            \n            \n              Cadeddu \n              JA. \n            \n          \n          Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. 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Surg Innov2007;14(4):279\u2013283"},{"issue":"6","key":"i0020-8868-101-3-153-b11","series-title":"Gastrointest Endosc","first-page":"1245","article-title":"Initial experience with hybrid transvaginal cholecystectomy","volume":"66","author":"Branco Filho \n              AJ,","year":"2007","unstructured":"Branco Filho \n              AJ, \n            \n            \n              Noda \n              RW, \n            \n            \n              Kondo \n              W, \n            \n            \n              Kawahara \n              N, \n            \n            \n              Rangel \n              M, \n            \n            \n              Branco \n              AW. \n            \n          \n          Initial experience with hybrid transvaginal cholecystectomy. 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Surg Endosc2011;25(4):1281\u20131286"},{"key":"i0020-8868-101-3-153-b17","series-title":"INTECH","article-title":"Transvaginal natural orifice transluminal endoscopic surgery (notes): surgical technique and results","author":"Kondo \n              W,","year":"2011","unstructured":"Kondo \n              W, \n            \n            \n              Branco Filho \n              AJ, \n            \n            \n              Branco \n              AW, \n            \n            \n              Charles \n              L, \n            \n            \n              Zomer \n              MT, \n            \n            \n              Bourdel \n              N, \n            \n            et al. \n          Transvaginal natural orifice transluminal endoscopic surgery (notes): surgical technique and results: INTECHOpen Access Publisher; 2011."},{"issue":"2","key":"i0020-8868-101-3-153-b18","series-title":"Surg Endosc","first-page":"329","article-title":"Group ASW. 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