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Background nbsp Natural nbsp Orifice nbsp Transluminal nbsp Endoscopic nbsp Surgery nbsp NOTES nbsp involves accessing the abdominal cavity through a natural orifice It provides easier access for the surgeon has a reduced recovery times and decreases postoperative pain Objective To present an initial experience with robotic natural orifice transluminal surgery R NOTES in gynecology using the da Vinci surgical system Case nbsp We present a case of a year old Asian female Gravida Para with irregular heavy menstrual cycle abnormal uterine bleeding due to uterine leiomyoma AUB L who under went Da Vinci Natural Orifice Transluminal Endoscopic Surgery NOTES total Laparoscopic hysterectomy TLH bilateral salpingectomy BS Lysis of nbsp adhesions nbsp LOA nbsp and nbsp cystoscopy nbsp The nbsp patient nbsp had nbsp uncomplicated nbsp recovery nbsp and postoperative care and was discharged on postoperative day zero Conclusion nbsp Robotic NOTES Total laparoscopic hysterectomy with bilateral salpingectomy is feasible and safe in gynecology patient This approach has the potential for a less morbid and scarless outcome

Background The incidence of adnexal masses in pregnancy is estimated to be Surgical intervention is required particularly in the setting of potential malignancy ovarian torsion or direct mass affect on the pregnancy Single incision laparoscopic surgery SILS averts the potential morbidity of multiple trocar insertions as it is associated with less bleeding pain and better cosmetics and tissue retrieval We describe the use of SILS technique in a week pregnancy complicated by a cm left adnexal cystic mass that was managed with a single incision laparoscopic left salpingectomy with cystectomy Case The patient was a year old pregnant Gravida Para with gestational diabetes and morbid obesity Body Mass Index of Her only pregnancy ended as a spontaneous abortion She initially presented to our clinic at weeks for further evaluation of a large x x cm maternal abdominal cystic mass which had been detected on prenatal ultrasound She was managed by Single Incision diagnostic laparoscopy and Single incision laparoscopic left salpingectomy and left paratubal cystectomy at weeks Pathologic examination of the paratubal cyst revealed the mass to be a benign mullerian serous cystadenofibroma Her recovery was uncomplicated with discharge on the first postoperative day Conclusion In summary removal of this patient s adnexal mass in pregnancy was warranted to avert potential complications The patient s paratubal cyst was drained without leakage and then removed intact through the umbilical incision Single incision laparoscopic cystectomy for large ovarian and paratubal cysts in pregnancy is not only feasible but has also been shown to result in better outcomes There were no complications in this patient intraoperatively postoperatively or in a subsequent pregnancy