Experience with transvaginal gallbladder removal in laparoscopic cholecystectomy

Kazuyuki Saito, MD, Nobumi Tagaya, PhD, Nana Makino, MD, Yawara Kubota, MD, Takashi Okuyama, PhD, Yoshitake Sugamata, PhD, Hidemaro Yoshiba, PhD, Masatoshi Oya, PhD

Department of Surgery, Dokkyo Medical University Koshigaya Hospital

Background: Natural Orifice Translumenal Endoscopic Surgery (NOTES) is gradually accepted into the standard laparoscopic surgery. We also introduced a modified technique of NOTES into laparoscopic cholecystectomy, and evaluated its technique and outcomes.

Materials and methods: Indication was postmenopausal women with obtaining informed consent. Recent 6 months, we performed 1) transvaginal gallbladder removal during laparoscopic cholecystectomy; one 5-mm umbilical port and two 3-mm ports at epigastric and right subcostal areas were inserted into the peritoneal cavity. Cholecystectomy was completed by these three ports under the guidance of 3.3-mm laparoscope through the right subcostal port. After obtaining the critical view, the cystic artery was divided using laparoscopic coagulating shears and the cystic duct was also divided after clipping. After retrieving the gallbladder into the plastic bag, it was removed from the vagina through the 12-mm port, and 2) laparoscopic cholecystectomy under transvaginal a long type 5-mm endoscopy; in the same setting of port placement, cholecystectomy was completed under the guidance of transvaginal laparoscopy during procedure. Gallbladder was also removed from vagina.

Results: The procedures were completed and no conversion to standard laparoscopic or open cholecystectomy. The mean operation time was 98 min and the estimated bleeding volume was minimal. A 3.3-mm needlescope had a higher quality image than the previous one and equipped a zoom function to realize a precise observation. The image of a long-type 5-mm ligid laparoscope from vagina is limited to visualize the Calot’s triangle. To create the operating field around the pouch of Douglas spent the operation time. There is no need to add the analgesics. Two 3-mm scars were invisible after operation.

Conclusion: Although the evaluation of a long-type laparoscope needs further study, this technique is feasible and safe to perform laparoscopic cholecystectomy for postmenopausal women with less postoperative pain and superior esthetic result.

Session: Poster Presentation

Program Number: P577

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