New Hybrid Approach for NOTES Transvaginal Cholecystectomy: Preliminary Clinical Experience

TLDR

NOTES is a pioneering approach toward scar‑less surgery. The study aims to assess early clinical outcomes of a novel transvaginal NOTES cholecystectomy technique. The procedure used a 2‑channel videoendoscope via a posterior colpotomy, two 3‑mm umbilical trocars, a 10‑mm colpotomy trocar, and combined endoscopic and 3‑mm laparoscopic instruments for dissection. In 12 women the technique had a mean operative time of 125.8 minutes, no intra‑operative complications except one vulvar laceration, no postoperative complications, and proved to be a feasible, safe, cosmetically advantageous, and low‑analgesic‑requirement alternative for cholecystectomy.

Abstract

Natural orifice translumenal endoscopic surgery (NOTES) represents the first step toward scar-less surgery. The objective of this study is to evaluate early clinical results of transvaginal cholecystectomy using a new technique.Institutional review board approval was obtained and transvaginal NOTES cholecystectomy was performed in 12 women for cholelithiasis. A 2-channel videoendoscope was inserted in the abdominal cavity through a posterior colpotomy. Two 3-mm trocars were inserted deep in the umbilicus, and a 10-mm trocar was placed through the colpotomy parallel to the endoscope. Dissection was performed with endoscopic instruments combined with 3-mm laparoscopic instruments.Mean operative time was 125.8 minutes. All procedures occurred without intraoperative complications or conversions, except for 1 vulvar laceration. There were no postoperative complications in the clinical follow-up.Transvaginal NOTES is a feasible and safe alternative for cholecystectomy in this preliminary clinical experience, allowing good cosmetic benefits and low analgesic requirement.