Pure transvaginal natural orifice translumenal endoscopic surgery for renal cyst decortication: report of initial five cases

Objective: To present our initial experience with pure transvaginal natural orifice translumenal endoscopic surgery renal cyst decortication.

Methods: From December 2010 to July 2011, five female patients with symptomatic renal cyst in the anterior portion and lower pole of the kidney were submitted to pure transvaginal natural orifice translumenal endoscopic surgery renal cyst decortication in our center. Under general anesthesia, the patients were placed in the lithotomy position with the affected side elevated by 60°. A 3-cm incision was made at the posterior vaginal fornix and a modified three-channel port was deployed across the vaginal incision. The cyst was dissected and the cyst fluid was aspirated using a suction device. The cyst wall was circumferentially excised.

Results: All five procedures were successfully carried out without additional transabdominal trocars. The median operative time was 80 min (range 60-90 min). The median estimated blood loss was 25 mL (range 25-50 mL). The median visual analog scale score was 1 on postoperative day 1. None of the patients required narcotic pain medications beyond postoperative day 2. Intestinal function recovered on postoperative day 1-3. There was no intraoperative or postoperative complication in any of the patients. During the follow-up visits, all the patients were in good condition. All the patients reported unaltered sexual function after surgery by the Female Sexual Function Index questionnaire.

Conclusion: Our initial experience suggests that pure transvaginal natural orifice translumenal endoscopic surgery renal cyst decortication is feasible and safe in selected patients.