Objectives: Transvaginal NOTES is a new diagnostic and potentially therapeutic method of surgical endoscopy, and clinical experience is still limited. A preliminary experience with NOTES transvaginal method for cholecystectomy is described.
Methods: IRB approval was obtained at the institution for transvaginal NOTES clinical trials. The technique of transvaginal NOTES cholecystectomy was clinically applied in 15patients with symptomatic cholelithiasis. Informed consent was obtained. Transvaginal NOTES access was obtained with an open posterior colpotomy after CO2 insufflation with a Veres needle transumbilically. The Double Channel Endoscope (GIF-2T160) Olympus Optical was introduced in the abdominal cavity transvaginally, as well as a 10 mm trocar in parallel, also transvaginally. There was combined endoscopic and laparoscopic dissection. There were 2 umbilical punctures for use of 3mm laparoscopic equipment. The posterior colpotomy was closed with chromic sutures.
Results: Operative time ranged from 85-260 min. Mean operative blood loss was estimated of 44ml, mostly from vaginal access. Mean abdominal CO2 pressure was 13mmHg. The total abdominal incision lenghts was 2x3mm on umbilical scar. There was also 3 of the gallbladder done from top down because the rigid instruments from the vagina limit the exposure of the gallbladder. The patients recovered well postoperatively, oral intake was began on the next day. The first four patients were dismissed on the third postoperative day, and the last patient was dismissed on the first postoperative day. There was need of Tramadol 50mg in 4 patients, and one patient claimed of vaginal discomfort. There were no postoperative complications.
Conclusions: Tranvaginal NOTES is a feasible and safe alternative method for cholecystectomy in this preliminary clinical experience. Available technology is still limited for natural orifice surgery, however this approach strongly suggests better cosmetic results and less pain.
Program Number: P292