[Transvaginal natural orifice translumenal endoscopic surgery partial gastrectomy: initial clinical experience]

Partial gastrectomy is a relatively simple procedure that involves perigastric mobilization and gastric resection/closure with surgical staplers. This procedure has been considered to be feasible using the transvaginal natural orifice translumenal endoscopic surgery (NOTES) approach. In this communication, we describe our clinical experience with transvaginal NOTES gastrectomy for gastric submucosal tumors. With the assistance of two transabdominal ports, "oncologically acceptable" partial gastrectomy was successfully performed. Transvaginal specimen delivery resulted in the prevention of morbid abdominal wall destruction, contributing to better cosmesis and reduced postoperative pain. To gain wider clinical acceptance, NOTES requires further evaluation of its indications, feasibility, and safety. Continuous research/developmental efforts are also essential to optimize its instrumentation. Its theoretical "minimal invasiveness" should be assessed in detail through further research, ideally in randomized trials.