New Hybrid Approach for NOTES Transvaginal Cholecystectomy: Preliminary Clinical Experience

Objectives. Natural orifice translumenal endoscopic surgery (NOTES) represents the first step toward scarless surgery. The objective of this study is to evaluate early clinical results of transvaginal cholecystectomy using a new technique. Methods. 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. Results. 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. Conclusion. Transvaginal NOTES is a feasible and safe alternative for cholecystectomy in this preliminary clinical experience, allowing good cosmetic benefits and low analgesic requirement.