Non-randomised, comparative, prospective study of transvaginal endoscopic cholecystectomy versus transparietal laparoscopic cholecystectomy

Natural orifice translumenal endoscopic surgery applications in clinical practice

“…The authors conclude, the only difference other than operative time, was that the NOTES procedure produced no visible scar. Noguera et al [10] 2009 performed a much smaller comparative analysis between laparoscopy and NOTES for cholecystectomies and report similar results to Zornig.…”

“…The authors are recruiting from multiple centres across the United States, aiming to recruit 200 patients to randomise [14] . There are also comparative analysis between NOTES and conventional laparoscopy to add strength to the trials by Zornig and Noguera, including a cost effectiveness analysis [9,10] . Notably, there is a large multi-centre international study of NOTES cholecystectomy registered [14] .…”

Emergency transvaginal hybrid natural orifice transluminal endoscopic surgery

“…The surgery was performed on an emergency basis by the surgical team on call. The surgical team consisted of two general surgeons with extensive experience in laparoscopic and transluminal endoscopic surgery following participation in transvaginal cholecystectomies that were performed during the local clinical hybrid NOTES trial [9,10]. Patients were consecutively enrolled in the study if they met the following conditions: American Society of Anesthesiologists physical status I -II, age between 18 and 65 years, In a clinical series, 10 consecutive female patients with intra-abdominal infections were successfully treated with natural orifice transluminal endoscopic surgery (NOTES) performed transvaginally.…”

“…1). A double-channel endoscope (video gastroscope 13 806 PKS, Karl Storz, Tuttlingen, Germany) was introduced through the trocar as far as the abdominal cavity under laparoscopic vision from the umbilicus, as reported previously [9,10]. An accessory 3-mm entry port was inserted into the right upper quadrant for gallbladder traction except in cases of adnexal infection and appendicitis, where the 5-mm umbilical trocar was the only parietal one used.…”

“…However, a hybrid NOTES procedure, with minimal transabdominal laparoscopic access, has been satisfactorily performed to treat both disorders. In cases of acute cholecystitis, the gallbladder was dissected through the endoscope using flexible tools, and with this approach the cholecystectomy took 20 minutes longer than a hybrid NOTES cholecystectomy performed electively: 86.5 vs. 69.5 minutes in our prospective clinical series [9]. The technique had been developed previously in the laboratory in an experimental animal model in which the gallbladder was dissected and removed in the presence of parietal tissue edema and inflammation [14].…”