Hybrid NOTES Cholecystectomy: Prospective Human Series

Introduction. Natural orifice transluminal endoscopic surgery (NOTES) makes it possible to perform intraperitoneal surgical procedures with a minimal number of access points in the abdominal wall. It is not yet possible at the present time to perform these interventions without the help of abdominal wall entryways, so these procedures are hybrids, a fusion of minilaparoscopy and transluminal endoscopic surgery. In this paper we present a prospective clinical series of 25 patients who underwent transvaginal hybrid cholecystectomy for cholelithiasis.

Methods. This was a prospective clinical series of 25 consecutive female patients, non-randomly chosen and without a control group, who underwent a fusion transvaginal NOTES and minilaparoscopy procedure with two trocars for cholelithiasis. One was umbilical and measured 5 mm , and the other was in the right upper quadrant and measured 3 mm

Results. The scheduled surgical intervention was performed on the 25 patients in whom it had been indicated. There were no intraoperative complications. One patient had mild hematuria that resolved in less than 12 hours; there were no other complications after an average follow-up period of 140 days. 20 patients were discharged in 24 hours, and 5 were discharged less than 12 hours after the procedure.

Discussion. Hybrid transvaginal cholecystectomy is a good surgical model for minimally invasive surgery, a combination of NOTES and minilaparoscopy. It can be performed in surgical settings where laparoscopy is practiced regularly, using the instruments normally used for endoscopy and laparoscopic surgery. Owing to the reproducibility of the intervention and the ease of vaginal closure, hybrid transvaginal cholecystectomy will permit further development of NOTES in the future.

Session: Podium Presentation

Program Number: S077

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