Transvaginal Laparoscopic Cholecystectomy Pain Study

Pratibh Vemulapalli, MD, Diego Camacho, MD, Scott Chudnoff, MD, Emanuel Agaba, MD, Harvey Rainville, MD. Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY

Background: The transvaginal laparoscopic cholecystectomy approach allows for reduced port placement in the abdominal wall where patients experience the most postoperative pain. We propose that this method will decrease early and late postoperative pain and allow for quicker return to daily activity.

Methods: The study comprised of a series of 5 nonrandomized women who underwent transvaginal laparoscopic cholecystectomy for symptomatic cholelithiasis. In all patients a standard 5mm port was placed in the ubilicus and in the posterior fornix of the vagina. In order to expose Calot’s triangle, the gallbladder was retracted cephalad with a 0 silk suture introduced on a straight Keith needle. All patients were evaluated for two weeks to assess pain levels, analgesic requirements, and return to activities of daily living.

Results: All patients experienced significantly less pain at the vaginal port site compared to the umbilicus. All patients reported an absence of pain and almost complete return to activity by postop day 3. There was also no use of pain medication after postop day 4.

Conclusion: Early experience with transvaginal laparoscopic cholecystectomy suggests improved postoperative pain, faster recovery and it offers a feasible alternative to traditional laparoscopic cholecystectomy