Natural Orifice Translumenal Endoscopic Surgery (NOTES) Transvaginal Cholecystectomy in a Morbidly Obese Patient

Abstract

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.

Diagnostic transgastric endoscopic peritoneoscopy: extension of the initial human trial for staging of pancreatic head masses

“…Transvaginal and transgastric accesses have been used recently as hybrid and stand-alone NOTES procedures for cholecystectomies and appendectomies in a human population [10][11][12][13][14][15][16][17][19][20][21]. The transcolonic approach also has been used during translumenal ventral hernia repairs and colon resections in a pig model [4,22].…”

“…Consequently, most human NOTES trials have used this technique. Cholecystectomies and appendectomies via a transvaginal approach have been described [10][11][12][13][14][15][16][17].…”

Totally NOTES (T-NOTES) transvaginal cholecystectomy using two endoscopes: preliminary report

“…Most published clinical applications of NOTES have shown good preliminary results, but strictly NOTES surgery without any laparoscopic assistance has not been achieved consistently. Technology for access still needs development by industry, and most centers use varying degrees of laparoscopic assistance for camera visualization, retraction, and dissection, or to achieve safe closure of the cystic duct and artery with laparoscopic clips [1][2][3][4][5][6][7][8][9]. Therefore, technical issues are limiting the no-incision principle of natural orifice surgery, thus leading to somatic postoperative pain and still maintaining the possibility for wound complications.…”

Transvaginal video-assisted cholecystectomy in clinical practice

“…Further successful transvaginal cholecystectomies, with either flexible or rigid instruments, were published in the same year by Zornig et al [25] from Germany, both Zorron [26] and Branco Filho [27] from Brazil, and Dolz [28] from Spain. Since then, there have been numerous reports on transvaginal cholecystectomy in humans [29][30][31][32][33][34][35]. So far all publications on transvaginal cholecystectomy concerned hybrid procedures.…”