NOTES: Transvaginal Cholecystectomy with Assisting Articulating Instruments

Introduction: Transvaginal cholecystectomy has been performed at several institutions using the hybrid NOTES techniques. Methods: The patient is a 42 year old female with symptomatic cholelithiasis. After obtaining informed consent, the patient was taken to the operating room for transvaginal cholecystectomy. A single 5 mm laparoscope was placed at the umbilicus, followed by a 15mm trocar through the vaginal conduit. The endoscope and a long flexible RealHand surgical instrument (Novare, Cupertino, CA) were placed via the vaginal trocar. The cystic duct and artery were identified and clipped using laparoscopic clips from the umbilical port. The long articulating laparoscopic instrument provided stable retraction. Hook cautery was used for dissection of the gallbladder, which was removed via the vaginal trocar. The vaginal incision was closed using a single figure-of-eight absorbable suture under direct vision. The procedure lasted 96 minutes. Results: The cholecystectomy was successfully performed without spillage of bile. The patient was kept overnight for observation only as a precaution. She reported no pain and did not require a discharge prescription for narcotics. Conclusions: This technique for NOTES cholecystectomy results in a virtually scarless operation. The single 5mm umbilical trocar allows for safe clipping of the cystic duct. Further work is needed to determine the efficacy of this approach.

Session: Podium Presentation

Program Number: V025