INTRODUCTION: Natural orifice transluminal endoscopic surgery (NOTES) has been widely discussed during the last years. Beside experimental work, clinical experience are still limited and most of the working groups only performed cholecystectomies.

 Up to now our clinical experience includes 50 cases (43 cholecystectomies, 4 gastric-sleeve resections, 2 colon resections, 1 appendectomy).

Here we present our first gastric-sleeve resection, which was the first case in Europe.

METHODS AND PROCEDURES: A 75 year old female with a chronic gastric ulcer was offered for a gastric resection. After an informed consent of the patient we have decided to perform a combined transvaginal-transumbilical approach for a gastric-sleeve resection of the great curvature by gastroscopic control.

At first, a 5mm optic trocar was inserted through the umbilicus. A 10mm trocar and a 5mm dissector were placed through the vagina. An additional 14mm trocar was placed in the left upper abdomen.

After dissection of the great curvature the sleeve resection was performed by 3 endo-ghias (60mm). The staple-line was oversewn by a running suture (3x0, absorble, monofil), the vaginal approach was closed by some single stitches.

RESULTS: Operation time was 75min. and the patient started food intake on the day of operation. She was discharged on day four after operation without any specific treatment. The histopathology of the specimen has showed no signs of malignancy.

CONCLUSION: Gastric-sleeve resection by NOTES using a combined transvaginal-transumbilical approach seems to be feasible in selected patients.