Transvaginal natural orifice translumenal endoscopic surgery (NOTES) is a new diagnostic and potentially therapeutic method of surgical endoscopy. The first case of NOTES transvaginal cholecystectomy in a morbid obese patient in the literature is described. IRB approval was obtained at the institution for transvaginal NOTES clinical trials. A 58-year-old female patient with cholelithiasis, hypertension, and type II diabetes, and BMI of 35.8 kg/m(2) was submitted to the technique. After transvaginal access, a two-channel gastroscope was introduced into the abdominal cavity along with a laparoscopic trocar. There were 2 umbilical punctures for use of 3 mm laparoscopic equipment. Operative time was 85 min. There was no use of postoperative analgesia, and the patient was discharged on the third postoperative day. Transvaginal NOTES is a feasible alternative method for cholecystectomy in the morbidly obese, although available technology is limited for natural orifice surgery.

Transvaginal NOTES is a feasible and safe alternative for cholecystectomy in this preliminary clinical experience, allowing good cosmetic benefits and low analgesic requirement.

Os autores apresentam uma revisão de 3102 colecistectomias realizadas no período de maio de 1993 à janeiro de 1996 no Serviço de Cirurgia Geral do Complexo Hospitalar da Santa Casa de Porto Alegre, onde encontraram 37 casos (0,012%) de carcinoma de vesícula biliar, sendo que o achado ocasional desta patologia foi de 40,5% neste grupo de pacientes. Concluem reafirmando a dificuldade diagnostica do carcinoma de vesícula biliar no pré-operatório e alertaram para que seja feito um exame minucioso no transoperatório com a confirmação do diagnóstico firmado pelo laudo anatomopatológico.

No abstract