• Skip to primary navigation
  • Skip to main content

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
      • SAGES Robotics Residents and Fellows Courses
      • MIS Fellows Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search the SAGES Site
    • Guidelines Search
    • Video Search
    • Search Images
    • Search Abstracts
  • OWLS/FLS
  • Login

Gynecologic Status After NOTES Transvaginal Cholecystectomy

Background: the development of NOTES procedures and its clinical application raise issues regarding the ways of access to the abdominal cavity. The transvaginal access through posterior colpotomy has been widely used by gynecologists for the treatment of several conditions and eliminates the disadvantages associated with other NOTES approaches ( transgastric, transrectal and trans-vesical).

Objective: assessment of the gynecological impact, both anatomical and functional, of the transvaginal NOTES access.

Methods and material: within a research protocol agreement between the Department of Surgery of the University of California, San Diego and the Department of Surgery of the University of Buenos Aires (Bocalandro Hospital) with IRB and approval of the Ethics Committe, 22 female patients were operated at this last institution between August 2007 and September 2008. The patients fulfilled the following requirements: a) symptomatic gallbladder stones, b) absence of common bile duct obstruction, c) previous pregnancy, d) negative pregnancy tests, e) mini- mental state evaluation of 14 or higher. The gynecologic screening included: a) thorough interrogation, b) examination including colposcopy, c) pelvic and transvaginal ultrasound.
A transvaginal NOTES cholecystectomy was attempted in the 22 patients with a hybrid technique: with laparoscopic control via a 5 mm umbilical trocar a 2 way trocar was inserted trough the right posterior vaginal cul de sac and endoscope, forceps and diverse instruments were inserted. Disecction of the cystic elements (duct and artery) and the Calot´s triangle was performed with electrocautery, scissors and Maryland forceps through the umbilical port, in a laparoscopic fashion. A 5 mm ligaclip instrument was introduced for placing titanium clips in the biliary and arterial structures. Once the gallbladder was divided from its attachments it was removed through the vagina. The access was closed with a running suture of absorbable vycril 2/0.
The postoperative follow up included gynecologic assessment at postoperative days 7, 30 and 60. The first 8 patients could resume normal sexual activity after 15 days and the remaining 14 have to wait 30 days. The evaluation included: guided questionnaire (patients´ satisfaction with the procedure, restart of sexual activity, spontaneous pain, dyspareunia), physical examination and colposcopy to assess healing, presence of anatomical injuries, vaginal secretion and other alterations.

Results: the operation with the NOTES hybrid technique could be completed in 21 of the 22 patients (95 %). In the remaining case the operation had to be performed laparoscopically due to pelvic adhesions (5 previous cesarean sections). One case ( # 6) required a minilaparotomy through a previous Pfannestiel incision for checking hemostasis of the vaginal cul de sac.
The systematic assessment prove adequate healing of the vaginal access with no local complications as well as absence of granulomas, hematomas, adhesions or retractions
Two patients restarted sexual relations before the 15 days prescribed, and the rest followed compliance with the indications. None of the patients refer or mention dyspareunia. Two patients got pregnant after the procedure and one underwent a normal birth delivery without complications.

Conclusions: the transvaginal NOTES access proves to be safe, with excellent outcomes, no complications and void of negative impact in the gynecologic and sexual aspects.


Session: Podium Presentation

Program Number: S078

53

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon

Related



  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2025 Society of American Gastrointestinal and Endoscopic Surgeons