Related Experiment Video
Updated: Apr 19, 2026
Surgical Robot-Assisted Transanal Specimen Extraction Radical Sigmoidectomy Without an Auxiliary Abdominal Incision
Published on: June 13, 2025
Comprehensive complication index for NOTES procedures: results from a randomized controlled trial and comparison to
Dietmar H Borchert1, Matthias Federlein2, Verena A Müller3
1Department of General, Visceral, Vascular and Pediatric Surgery, and Institute of Biometry, Epidemiology and Medical Informatics, Saarland University Hospitals, Kirrberger Straße 100, 66421, Homburg, Saarland, Germany. dietmar.borchert@doctors.org.uk.
The Comprehensive Complication Index (CCI) offers a standardized method for comparing complications in Natural Orifice Transluminal Endoscopic Surgery (NOTES) procedures. This index facilitates international comparison and highlights the importance of reporting minor complications.
Area of Science:
- Minimally invasive surgery
- Surgical outcomes research
- Medical device and procedure analysis
Background:
- Natural Orifice Transluminal Endoscopic Surgery (NOTES) aims to reduce surgical trauma.
- Inconsistent complication reporting in NOTES literature hinders comparative analysis.
- The Comprehensive Complication Index (CCI) provides a standardized approach to complication assessment.
Purpose of the Study:
- To evaluate the utility of the Comprehensive Complication Index (CCI) for comparing complications in Natural Orifice Transluminal Endoscopic Surgery (NOTES) procedures.
- To compare complication rates between transvaginal cholecystectomy (TVC) and conventional laparoscopic cholecystectomy (CLC) using the CCI.
- To assess the impact of varying complication definitions on reported outcomes.
Main Methods:
- A randomized controlled trial comparing transvaginal cholecystectomy (TVC) and conventional laparoscopic cholecystectomy (CLC) was utilized.
- Complications were assessed using the Classification of Surgical Complications (CSC) under two different scenarios.
- Data were inputted into an online CCI calculator, and results were compared with other NOTES publications.
Main Results:
- The CCI provided a single, easily interpretable index for surgical complications.
- Mean CCI values for both CLC and TVC were below 8.7, indicating low complication rates.
- Significant differences in interpretation arose based on the definition of complications used.
Conclusions:
- The CCI enables straightforward, international comparison of complication rates in surgical procedures.
- Clear definitions of complications are crucial for accurate reporting with both CSC and CCI.
- Standardized reporting, particularly of minor complications, is essential for advancing NOTES procedures.
