NOTES transvaginal cholecystectomy: preliminary clinical application.

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Natural Orifice Translumenal Endoscopic Surgery (NOTES) is an emerging surgical concept with potential clinical benefits.
• Human applications of NOTES have been limited due to technical and ethical challenges, particularly with transgastric approaches.
• Transvaginal NOTES cholecystectomy offers a promising alternative, addressing some of these limitations.

Purpose of the Study:

• To describe the preliminary clinical application of transvaginal NOTES cholecystectomy.
• To evaluate the safety, feasibility, and potential benefits of this novel surgical technique.
• To compare transvaginal NOTES with other NOTES approaches.

Main Methods:

• Four female patients underwent transvaginal NOTES cholecystectomy after institutional ethics committee approval and informed consent.
• Transvaginal access was achieved using conventional instruments, with a colonoscope inserted into the abdominal cavity.
• Pneumoperitoneum was established with CO2, and instruments were used through the colonoscope for gallbladder removal and vaginal wound closure.

Main Results:

• The transvaginal NOTES cholecystectomy was successful in all four patients.
• Operative times ranged from 45 to 115 minutes.
• Patients experienced minimal need for analgesia, resumed oral intake within 2 hours, and were discharged 48 hours post-procedure with no complications.

Conclusions:

• Transvaginal NOTES cholecystectomy demonstrated feasibility and safety in this initial patient cohort.
• The developed transvaginal technique, distinct from transgastric NOTES, shows potential as a preferred method for future clinical research.