Prospective Non-randomized Study of Endoscopic Transvaginal Cholecystectomy Versus Laparoscopic Cholecystectomy

Introduction. Natural orifice transluminal endoscopic surgery (NOTES) makes it possible to perform intraperitoneal surgical procedures with a minimal number of access points in the abdominal wall. At the present time these procedures are hybrids. It is expected a better cosmetic result and lower incidence in parietal complications in front of laparoscopic cholecystectomy, but is necessary to investigate that these benefits should not be associated with complications of the new access to abdominal cavity. We report a non-randomized prospective study in 80 patients to evaluate the clinical safety and efficacy of transvaginal endoscopic approach in resolution of gallstones.
Methods. Prospective non-randomized clinical series of 40 female patients with gallstones that underwent endoscopic surgery, 40 of them operated with conventional laparoscopic approach and 40 of them by transvaginal endoscopic approach. Variables as surgical wound infection, urinary tract infection, evisceration, hernia, mortality and other complications were analyzed.
Results. The planned intervention was conducted in 80 patients where indicated. There were no intraoperative complications for conversion to open surgery. There were no cases of mortality associated with the procedures and there was only one postoperative complication, urinary tract infection in a patient operated by transvaginal technique. The average follow-up was the same in both groups (12 months). The average postoperative stay in both groups was less than 0.8 days. Operative time was greater in the group with transvaginal approach, with 69.5 minutes compared with 46.2 in the laparoscopic group.
Discussion. Hybrid transvaginal cholecystectomy is a valid model for minimally invasive surgery. It can be performed in surgical settings where laparoscopy is practiced regularly, with similar results to that obtained with laparoscopic approach. While the cosmetic advantage is obvious, in this series were not found differences in parietal complications. The operative time of transvaginal approach is longer in 20 minutes, but both operative times are acceptable. More wide prospective series are needed, with more patients and longer follow-up in order to discuss improvements of the transvaginal approach in relation to the injury of the abdominal wall. This study values the non-inferiority in efficacy and safety for transvaginal approach in front of conventional approach.


Session: Podium Presentation

Program Number: S044

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