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Related Experiment Video

Updated: Jun 24, 2026

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

Published on: November 25, 2025

Totally NOTES (T-NOTES) transvaginal cholecystectomy using two endoscopes: preliminary report.

Luiz Henrique de Sousa¹, José Américo Gomides de Sousa, Luiz Henrique de Sousa Filho

¹Department of Surgery and Endoscopy, SOUSAGROUP Hospital Femina, Goiania Caixa postal 22812, CEP 74 850-970, Goiania, Brazil. drluizhs@terra.com.br

Surgical Endoscopy

|April 4, 2009

Summary

This study demonstrates a feasible transvaginal cholecystectomy using two endoscopes, a novel Totally Natural Orifice Transluminal Endoscopic Surgery (T-NOTES) approach. The technique successfully removed gallbladders with no complications in four patients, offering a scarless surgical option.

Related Experiment Videos

Last Updated: Jun 24, 2026

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture

Published on: November 25, 2025

Area of Science:

Minimally Invasive Surgery
Gastroenterology
Surgical Innovation

Background:

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) applications are limited, often requiring hybrid laparoscopic assistance.
The primary goal of natural orifice surgery is to avoid complications associated with abdominal incisions.
This study introduces a novel technique for transvaginal cholecystectomy using two endoscopes.

Purpose of the Study:

To report on a developed technique for Totally NOTES (T-NOTES) transvaginal cholecystectomy.
To describe the preliminary results of this innovative surgical approach.
To evaluate the feasibility of using two endoscopes for transvaginal gallbladder removal.

Main Methods:

The study obtained Institutional Review Board (IRB) approval and informed consent for transvaginal NOTES clinical trials.
Four female patients with symptomatic cholelithiasis underwent the T-NOTES transvaginal cholecystectomy procedure.
Transvaginal access was achieved via vaginal incision, with simultaneous introduction of two endoscopes for dissection and ligation using endoscopic clips.

Main Results:

The transvaginal T-NOTES cholecystectomy technique was successfully performed in all four patients.
Operative time averaged 210 minutes, with good insufflation and spatial orientation.
No complications were observed during the 30-day follow-up, with patients discharged on postoperative day one.

Conclusions:

Transvaginal T-NOTES using two endoscopes presents a feasible method for natural orifice cholecystectomy with current technology.
The approach offers a potential scarless alternative for gallbladder removal.
Further large-series studies are required to fully assess the safety and efficacy of this technique.