Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2021; 9(7): 1714-1719
Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1714
Pure transvaginal natural orifice transluminal endoscopic surgery right hemicolectomy for colon cancer: A case report
Zi-Jia Song, Yi-Qing Shi, Yi-Mei Jiang, Kun Liu, You Li, Chang-Gang Wang, Ren Zhao
Zi-Jia Song, Yi-Qing Shi, Yi-Mei Jiang, Kun Liu, You Li, Chang-Gang Wang, Ren Zhao, Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
Author contributions: Song ZJ and Shi YQ contributed equally to this study; Song ZJ, Shi YQ, and Zhao R were the patient’s surgeons, reviewed the literature, and contributed to manuscript drafting and revision for important intellectual content; Jiang YM, Liu K, Li Y, and Wang CG reviewed the literature and contributed to manuscript drafting; Song ZJ, Shi YQ, and Wang CG edited the surgical video; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ren Zhao, FACS, MD, PhD, Chief Doctor, Professor, Surgeon, Surgical Oncologist, Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No. 999 Xiwang Road, Jiading District, Shanghai 201801, China.
Received: October 29, 2020
Peer-review started: October 29, 2020
First decision: December 8, 2020
Revised: December 22, 2020
Accepted: January 6, 2021
Article in press: January 6, 2021
Published online: March 6, 2021

Pure natural orifice transluminal endoscopic surgery (NOTES) for colorectal cancer is a complex procedure and rarely used in clinical practice because of the ethical concerns and technical challenges, including loss of triangulation, in-line orientation, and instrument collision. Transvaginal (v) NOTES, however, can overcome these technical challenges. We report a case of pure vNOTES right hemicolectomy for colon cancer, attached with surgical video.


A 65-year-old woman with a 2-year history of intermittent diarrhea was diagnosed with ascending colon adenocarcinoma by colonoscopy and biopsy. Pure vNOTES right hemicolectomy was performed with complete mesocolic excision by well-experienced surgeons. The operative time was 200 min and the estimated blood loss was 30 mL. No intraoperative or postoperative complications occurred within 30 d after the surgery. The visual analog scale pain score on postoperative day 1 was 1 and dropped to 0 on postoperative days 2 and 3. The patient was discharged at postoperative day 6. The pathologic specimen had sufficient clear resection margins and 14 negative harvested lymph nodes.


vNOTES right hemicolectomy, performed by well-experienced surgeons, overcomes the technical challenges of pure NOTES and may be feasible for colon cancer.

Keywords: Natural orifice transluminal endoscopic surgery, Colon cancer, Right hemicolectomy, Complete mesocolic excision, Surgical video, Case report

Core Tip: Pure natural orifice transluminal endoscopic surgery (NOTES) for colon cancer is rarely used in clinical practice because of the complex surgical procedures, technical challenges, and ethical concerns. To the best of our knowledge, there has been no previous report on transvaginal (v) NOTES right hemicolectomy for colon cancer. In this paper, we report our preliminary clinical experience with successful pure vNOTES treatment of a 65-year-old woman with ascending colon adenocarci-noma.