Pure NOTES Cholecystectomy

Initial excitement for Natural Orifice Transluminal Endoscopic Surgery (NOTES) has been partly tempered by the reality that a NOTES procedure without laparoscopic or needleoscopic-assistance has not been widely performed. After safely performing laparoscopically-assisted transvaginal cholecystectomy in an IACUC-approved porcine model, we embarked on an IRB-approved protocol to ultimately perform a pure NOTES cholecystectomy.
We describe our experience with performing a true NOTES transvaginal cholecystectomy after safely accomplishing 3 laparoscopically-assisted or hybrid procedures in humans. The patient is a 35-year-old woman presenting with symptoms of biliary colic and ultrasound confirmed gallstones, her liver enzyme were normal.
Via a transvaginally-placed trocar made through a colpotomy under direct vision, pneumoperitoneum to 15torr was obtained. A double channel endoscope was then advanced into the abdomen. To overcome the retracting limitations of currently available endoscopes, we used an extra long 5mm articulating retractor that was placed into the abdomen via a separate colpotomy. Endoscopically-placed clips were used for both the cystic duct and artery, thus, obviating the need for any transabdominally placed instruments or needles.
This patient was the first patient to undergo a completely NOTES cholecystectomy at our institution, she was discharged on the day of surgery and has not suffered any complication after 1 month of follow-up.
NOTES Transvaginal Cholecystectomy without aid of laparoscopic or needleoscopic instruments is feasible and safe in humans. Additional experience with this technique will be required before comparative studies to standard laparoscopy and hybrid techniques are appropriate.

Session: Podium Video Presentation

Program Number: V025

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