Introduction. The biggest problem for safeness of NOTES is the great possibility of contamination spreading from natural orifice into the peritoneal cavity. Currently transvaginal approach seems to be the simplest in access and wound closure. Thus, the aim of our study was evaluation of peritoneal contamination and adhesions formation after transvaginal and transumbilical rendezvous approach to abdominal cavity.
Methods and procedures. In 2007, 3 females with gallstones underwent transvaginal and transumbilical rendezvous cholecystectomy. Mean age of women was 51 (range, 45 – 56). Preoperative examination included gynecological examination, US, CT, GI endoscopy, blood analyses and vaginal bacteriological tests. Intraoperatively the peritoneal bacteriological tests and evaluation of the degree of adhesive process were performed. Postoperative examination included gynecological examination, bacteriological tests, US, ÑT and blood analyses. Preoperative US data, blood analyses and bacteriological tests of blood and vaginal inoculations were normal in every patient. Technique. The pneumoperitoneum was applied by puncture of umbilical ring. Then, 5-mm trocar was placed at the site of puncture. Initially this trocar was used for 5-mm laparoscope. After decontamination of vagina, under the guidance of laparoscope, the endoscope was passed via the colpostomy into the abdominal cavity. The initial movements of endoscope were controlled by laparoscope. The traction of the gallbladder was performed by the 2,8-mm endoscopic graspers placed via the instrumential channels of endoscope. The basic instruments (electrosurgical hook, clip-applier, ect.) were placed via the 5-mm trocar. The gallbladder was removed through the colpostomy. The colpostomic wound was sutured in a usual manner.
Results. Mean surgery time was 105 min (range, 95 – 125). There were no postoperative morbidity and mortality. Intraopertaively no adhesions in pelvic space were found and peritoneal bacteriological tests were negative. Postoperative blood analyses were normal in every patient. Postoperative bàcteriological tests of blood were negative in every patient. There were no US and CT data for inflammatory or adhesive process in the pelvic space and no failure of vaginal fornix sutures in every patient.
Conclusions: Transvaginal and transumbilical rendezvous cholecystectomy is safe and feasible procedure for practice and further study of NOTES.
Program Number: P212