NOTES Transvaginal Cholecystectomy: Report of the First Case

TLDR

Natural Orifice Translumenal Endoscopic Surgery (NOTES) is a novel field with potential patient benefits, yet technical and ethical challenges such as organ perforation, closure, and limited understanding of physiopathology have prevented clinical application. This study reports the first clinical transvaginal NOTES cholecystectomy and outlines ongoing research into instrument development and physiological understanding to enable more advanced procedures. On March 13, 2007, a 43‑year‑old woman underwent elective transvaginal NOTES cholecystectomy using a colonoscope, endoscopic graspers, and a vaginal platform. The operation lasted 66 minutes, with 15 minutes for vaginal access and closure; the patient recovered well and was discharged within 48 hours, and the study suggests transvaginal NOTES may offer earlier benefits than transgastric approaches due to lower risk of fistula and peritonitis.

Abstract

Natural Orifice Translumenal Endoscopic Surgery is a new development area with potential advantages for patients. However, technical and ethical challenges involved in perforation and closure of a healthy organ, as seen in transgastric access, and lack of comprehension of physiopathology of these approaches haven't allowed clinical application. The present study, based on previous animal experiments, describes the first clinical application of transvaginal Natural Orifice Translumenal Endoscopic Surgery. On March 13, 2007, a 43-year-old female patient with symptomatic cholelithiasis with surgical indication was submitted to elective Natural Orifice Translumenal Endoscopic Surgery transvaginal cholecystectomy using a colonoscope, endoscopic graspers, and vaginal platform instruments. Operative time was 66 minutes, and vaginal access and closure were obtained in 15 minutes. The patient had good postoperative evolution and was dismissed within 48 hours without complications. Recent literature and experience of the present study group suggest possibilities for preliminary clinical applications by transvaginal natural orifice surgery. The access may offer earlier benefits in the literature than the transgastric route because of lack of danger of fistula and peritonitis. Further studies regarding instrument development and physiology of natural orifice surgery are ongoing, possibly bringing solutions for more advanced procedures.