Video. Magnetic retraction for NOTES transvaginal cholecystectomy.

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Natural orifice translumenal endoscopic surgery (NOTES) offers reduced patient burden but faces limitations in retraction and surgical comparability.
• Laparoscopic cholecystectomy remains the gold standard, necessitating advancements in endoscopic techniques.

Purpose of the Study:

• To evaluate the feasibility and safety of transvaginal cholecystectomy using current endoscopic technology.
• To assess the potential of NOTES for gallbladder removal as an alternative to traditional laparoscopic surgery.

Main Methods:

• Four patients underwent transvaginal cholecystectomy under laparoscopic vision.
• Procedures utilized a 15-mm vaginal trocar, an articulating instrument, and a magnetic retraction system for gallbladder manipulation.
• Ligation of the cystic duct and artery was achieved using laparoscopic clips.

Main Results:

• All four transvaginal cholecystectomies were completed successfully without any intraoperative or postoperative complications.
• Patients were discharged shortly after surgery and resumed normal sexual activity without pain.
• The average operative time for the procedure was 102 minutes.

Conclusions:

• Transvaginal cholecystectomy is a safe and feasible procedure with current technology.
• Further research is required to establish the long-term safety and potential benefits of this NOTES approach beyond cosmetic advantages.