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Transvaginal access for NOTES: a cohort study of microbiological colonization and contamination

G R Linke1, I Tarantino, T Bruderer

  • 1Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany. gelinke@web.de

Endoscopy
|April 25, 2012
PubMed
Abstract

Insights

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) involves minimal peritoneal contamination when vaginal disinfection is used. This prospective study found a low risk of infection, with no postoperative surgical site infections in patients undergoing transvaginal cholecystectomy.

Area of Science:

  • Minimally invasive surgery
  • Gastroenterology
  • Surgical infection prevention

Background:

  • Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) shows promise for reduced infection risk.
  • Limited data exists on microbiological contamination during transvaginal access.
  • Systematic evaluation of peritoneal contamination in transvaginal NOTES is needed.

Purpose of the Study:

  • To assess peritoneal cavity contamination from transvaginal NOTES access.
  • To evaluate the efficacy of preoperative vaginal disinfection on vaginal colonization.
  • To determine the infection risk associated with transvaginal cholecystectomy.

Main Methods:

  • Prospective cohort study of female patients undergoing transvaginal rigid-hybrid cholecystectomy (tvCCE) or laparoscopic cholecystectomy.
  • Vaginal disinfection with hexetidine and octenidine was performed prior to tvCCE.
  • Bacterial swabs of the posterior fornix and peritoneal cavity were collected at intervals.

Main Results:

  • Transvaginal access resulted in minimal peritoneal contamination (4% pre-access, 7% post-closure).
  • Vaginal disinfection significantly reduced bacterial load (P=0.001) and growth (P<0.001).
  • No postoperative surgical site infections were observed (95% CI 0%-12.5%).

Conclusions:

  • Transvaginal NOTES access is associated with a low risk of peritoneal contamination in selected patients.
  • Preoperative vaginal antisepsis is effective in reducing vaginal bacterial load.
  • Transvaginal cholecystectomy demonstrates a favorable safety profile regarding surgical site infections.

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