[Transvaginal notes Cholecystectomy in humans: first series of cases in Costa Rica]

OBJECTIVES. To report the first case series of transvaginal NOTES cholecystectomy in humans in Costa Rica and its clinical potential in the treatment of abdominal diseases in this country. PATIENTS AND METHODS. We present a series of three cases of adult female patients of 44, 58 and 69 years of age (average 57 years), symptomatic, with a gall bladder polyp diagnosed by an abdominal ultrasound, who underwent a transvaginal cholecystectomy modified with laparoscopic technique. A 5 mm trocar was inserted through the umbilicus to create and to monitor the pneumoperitoneum, as well as to possibilitate endoscopic vision during the intravaginal introduction of an endoscope and a forceps device for cephalic retraction of the gall bladder. Through the intraumbilical trocar a conventional laparoscopic hook device was also inserted for dissection of the pedicle and hepatic bed, and also a laparoscopic clip applier for clipping of the cystic artery and duct. The gall bladder was extracted through the vagina. RESULTS. The three cases were successfully performed without intra- or postoperative complications. The average operative time was 107 minutes (range 100-115 minutes). The patients were discharged within 24 hours. At the 1-month follow-up, none of the patients complained neither of incisional pain nor dyspareunia. CONCLUSION. The transvaginal NOTES cholecystectomy combined with laparoscopic technique is feasible, safe, reproducible, and constitutes one step further in the development of pure NOTES procedures. More effort in technological investigation and dedication is to be required to apply this technique to other more complex procedures.