Transvaginal laparoscopic cholecystectomy (hybrid NOTES cholecystectomy)

Area of Science:

• Minimally Invasive Surgery
• Surgical Innovation
• Gastrointestinal Endoscopy

Background:

• Natural Orifice Transluminal Endoscopic Surgery (NOTES) typically uses flexible endoscopes, which have manipulation limitations for intra-abdominal organs.
• Conventional laparoscopic instruments offer improved dexterity and eliminate the need for specialized training or new equipment.
• Single-Port Access (SPA) techniques can be adapted for transvaginal procedures to prevent port-related complications like air leakage.

Observation:

• A 54-year-old female patient with uterine prolapse and symptomatic gallstones underwent a combined transvaginal laparoscopic cholecystectomy and hysterectomy.
• The procedure utilized standard laparoscopic instruments, with a gynecologist performing the hysterectomy after the cholecystectomy.
• The cholecystectomy operative time was 86 minutes, and the patient was discharged on postoperative day 8.

Findings:

• Transvaginal laparoscopic surgery using conventional instruments is feasible for combined procedures like cholecystectomy and hysterectomy.
• This hybrid approach leverages the benefits of NOTES and SPA surgery, enhancing operative efficiency.
• The technique demonstrated successful application in a clinical case, with a reasonable operative time and recovery period.

Implications:

• This approach offers a viable alternative to traditional laparoscopy and flexible endoscopy for certain combined abdominal and pelvic surgeries.
• It highlights the potential for adapting existing laparoscopic tools and SPA principles to transvaginal NOTES procedures.
• Further research may explore the broader applicability and long-term outcomes of this innovative surgical technique.