Guidewire slippage into the peritoneal cavity during clinical operations is extremely rare. Therefore, this paper aims to report a successful case of guidewire removal using transgastric natural orifice transluminal endoscopic surgery (NOTES). The goal is to enhance physicians' understanding of the management plan for this unique scenario and provide a valuable reference for clinical practice.

A 64-year-old man presented with abdominal distension and was diagnosed with cirrhosis combined with massive ascites. To proceed with treatment, the patient underwent ultrasound-guided peritoneal puncture and underwent catheterization and drainage. Unfortunately, a 0.035-inch guidewire slipped into the abdominal cavity during the procedure. Following a comprehensive evaluation and consultation by a multidisciplinary team, the guidewire was successfully removed using NOTES.

This case highlights the potential consideration of transgastric NOTES removal when encountering a foreign body, such as a guidewire, within the abdominal cavity.

Recent technologic advances in endoscopic instrumentation and optics have allowed the development of a less invasive alternative to conventional laparoscopic surgery. During the past decade, natural orifice transluminal endoscopic surgery (NOTES) flourished in the field of general surgery, and it has emerged as a new concept of minimally invasive surgery. NOTES yields access to the abdominal cavity without any incisions on the abdominal wall (scarless surgery), and the natural orifices of the body surface, such as the mouth and the vagina, serve as the gateway to the peritoneal cavity. In gynecology, the vagina of a woman can be considered as an additional route for surgery. Recently, clinical application of transvaginal NOTES has broadened significantly in gynecology. Using transvaginal NOTES by applying the method of single-incision laparoscopic surgery via the vaginal route, not only adnexal surgery and hysterectomy, but also myomectomy and oncologic surgery could be performed safely and effectively in selected patients. In future, further studies should be conducted to evaluate the true clinical feasibility and safety of transvaginal NOTES.