Transvaginal NOTES hybrid cholecystectomy: feasibility results in 68 cases with mid-term follow-up

Background and study aims: Natural orifice transluminal endoscopic surgery (NOTES) has been tested in the animal model for a multitude of procedures including cholecystectomy. Clinical experience using flexible endoscopes is, however, very limited. Transvaginal cholecystectomy has been shown to be the most feasible approach in which rigid instruments can be used. We report our experience in all patients treated over a 1-year period. Patients and methods: Between June 2007 and June 2008, 68 patients (mean age 50 years) underwent transvaginal cholecystectomy with an additional 5-mm umbilical trocar using rigid laparoscopic instruments. Data about symptoms, operation, and postoperative course were prospectively collected, as were findings of a gynecological follow-up examination I week after surgery and the results of an interview at least 3 months after surgery. Results: All 68 operations were finished successfully without conversion, with a mean operation time of 51 minutes; in three additional cases severe pelvic adhesions prevented further transvaginal progress. There were no intraoperative or immediately postoperative complications, but one patient presented with a Douglas Pouch abscess 3 weeks after Surgery. Gynecologic followup exams I week after surgery were unremarkable. All patients were interviewed 3 - 10 months after surgery and had no abdominal or gynecological complaints including in relation to sexual intercourse. Conclusion: Transvaginal NOTES cholecystectomy with rigid instruments can be safely and effectively performed in daily routine.