NOTES transvaginal video-assisted cholecystectomy: first series

Background and study aims: Extensive research has been conducted to develop natural-orifice transluminal endoscopic surgery (NOTES) as a new approach to less invasive surgery. Our aim is to present the technique and initial prospective results of a transvaginal video-assisted laparoscopic approach to NOTES cholecystectomy in order to perform minimally invasive surgery without visible scars. Patients and methods: From July 2007 to March 2008, 32 women underwent transvaginal video-assisted laparoscopic cholecystectomy using a transvaginal 10-mm 45 degrees rigid bariatric optic through a 12-mm bariatric trocar and two abdominal trocars (2-mm and 5-mm). Data on the history, surgical time, complications, and recovery were recorded prospectively in each case. Results: Mean age was 33 years (range 22-47 years); mean body mass index was 29 (range 20-42). Mean operative time was 38 minutes (range 18-50 minutes). Patients were discharged 6 hours after the procedure without the need for pain medication in the following days and returned to normal working activities within 24 hours of the procedure. Conclusions: Transvaginal video-assisted NOTES cholecystectomy seems to be an efficient and safe approach to minimally invasive surgery, providing patients with a comfortable recovery with virtually no abdominal scars as a bridge to exclusively NOTES procedures.