[Notes-hybrid: splenectomy (transvaginal/umbilical)]

In the search of less invasive surgery, laparoscopic procedures through natural orifices accesses have begun to be standardized Considering that women have the higher prevalence of idiopathic thrombocytopenic purpura, the purpose of this presentation is to demonstrate our first experience performing a hybrid NOTES (natural orifice transluminal endoscopic surgery) splenectomy, with the transvaginal and umbilical-multi-port access as doors to perform the procedure. We present a 30-year-old woman with body mass index 22 kg/m2 and platelet count 55,000 per microliter-x103/uL. A refractory autoimmune thrombocytopenic purpura was diagnosed. Splenectomy was performed through the umbilical-multi-port and transvaginal accesses, with the use of conventional laparoscopic instruments and video sigmoidosocopy. The surgical specimen was removed vaginally by fragmentation of the piece. The mean operative time was 150 minutes, the blood loss 100 cc, the postoperative pain analog scale 1, and the follow-up 8 weeks. Currently the patient has a platelet count of 450,000 per microliter and she is free of treatment with steroids or any immunosuppressive drugs. We conclude that the transvaginal and umbilical hybrid NOTES constitutes an option to perform splenectomy in selected patients.