Single Incision Transvaginal Cholecystectomy

AMBAR BANERJEE, MD, JEFFREY W HAZEY, MD, DAVID B RENTON, MD, JACQUELINE ROHL, MD, BRADLEY ZAGOL, MD, W S MELVIN, MD, VIMAL K NARULA, MD. Center for Minimally Invasive Surgery, Division of Gastrointestinal Surgery, The Ohio State University

Introduction: Transvaginal Cholecystectomy has been reported from several places internationally as well as in the United States. Single incision cholecystectomy is well documented. Reported herein, we applied single incision techniques and instrumentation to perform a transvaginal cholecystectomy.

Technique: After obtaining Institutional Review Board (IRB) approval, a 42 year old female with a history of symptomatic cholelithiasis was consented for a hybrid laparoscopic-assisted transvaginal cholecystectomy. Following the induction of anesthesia, we inserted a 5mm 30-degree laparoscope in the abdomen through a 5mm infra-umbilical incision after obtaining the desired pneumoperitoneum. The Gynecology team made a posterior colpotomy through which an Olympus™ Triport Access System was introduced into the peritoneal cavity under direct laparoscopic visualization. Two long 5mm atraumatic graspers were introduced through the triport along with a single-lumen diagnostic endoscope and were advanced up to the right upper quadrant of the patient. Next, under endoscopic vision, the cystic duct and artery were isolated, clipped and divided. The gall bladder was removed from the liver bed by hook electrocautery. The specimen was brought out through the transvaginal port using an Endocatch™ (Covidien). The peritoneal cavity was inspected with the laparoscope to rule out any injury before closing the abdominal incision. The vaginal incision was closed by our counterparts.

Result: Operative time was 90 minutes. The patient tolerated the procedure well and was admitted overnight for observation. She did not require narcotic pain medications beyond post-operative day two. Her follow-up two weeks post surgery was unremarkable. She reported a zero score on the visual analog scale for pain assessment.

Conclusion: Single incision experience can be successfully applied to transvaginal / NOTES cholecystectomy. These techniques may shorten the operative time when performing NOTES procedures.