Transgastric hybrid cholecystectomy

Background: Clinical application of natural orifice transluminal endoscopic surgery is under investigation. Preliminary results of transvaginal cholecystectomy in women and associated technical issues have been described. The technique and initial results of hybrid transgastric cholecystectomy are now reported. Methods: Five patients; aged 18-60 years with Uncomplicated cholelithiasis underwent transgastric cholecystectomy in a prospective intention-to-treat study that included the Option of transparietal assistance (hybrid technique) if needed. The gastrotomy was created under laparoscopic guidance through a 5-mm umbilical trocar, which also served to expose the gallbladder, clip the cystic pedicle and close the gastrotomy. Cholecystectomy was carried out using flexible instruments through the endoscope, alone or in combination with laparoscopic instruments. Results: The procedure was successful in all patients with a median operating time of 150 (range 120-180) min. Transparietal assistance was necessary in all patients. There were no intraoperative or postoperative complications. Conclusion: Until technical issues have been resolved, a hybrid procedure with liberal use of transparietal assistance is the safest and most efficient approach for transgastric cholecystectomy. Further studies essential to evaluate the role of this new approach.