Skip to main content
SpringerLink
Log in

Hybrid NOTES transvaginal cholecystectomy: operative and long-term results after 18 cases

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique that aims at reducing or abolishing skin incisions and potentially also postoperative pain. The purpose of this study was to analyse operative and long-term results of a series of hybrid transvaginal cholecystectomy.

Materials and methods

Between July 2007 and May 2009, transvaginal NOTES cholecystectomy for symptomatic cholelithiasis was performed by a hybrid technique in 18 women (mean age 54 years), including four women with a body mass index >30 kg/m2. Dissection was conducted in the first four cases by a round-tip unipolar electrode (UE) introduced through the operative channel of the endoscope coming from the vagina and in the last 14 cases by a ultrasonic scalpel (US) introduced through a 5-mm abdominal port. The short-term outcomes and the long-term results of the two methods were compared.

Results

The transvaginal approach entailed no intraoperative complication and no conversion. The overall mean duration of procedures was 75 min (range 40–190). In the first four cases (UE), the operating time was 148 min (range 140–190), whilst in the last 14 (US), it was considerably shorter, 53 min (range 40–60, p < 0.01). We experienced one biliary leak in the UE group, whilst morbidity with US was nil (p < 0.005). The biliary leak healed in 7 days with nasobiliary drainage. No other complications were encountered in either group. The mean follow-up was 12 months (range 1–22), and none of the patients has complained of dyspareunia or other colpotomy-related complications so far.

Conclusions

Until specifically designed endoscopic tools are available for NOTES, the hybrid technique with US dissection conducted through a 5-mm port should be preferred in transvaginal cholecystectomy in order to shorten the duration of surgery and make this approach effective, safe and reproducible. After a mean follow-up of 1 year, none of our patients has complained of any problem related to transvaginal approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kalloo AN, Singh VK, Jagannath SB et al (2004) Flexible transgastric peritoneoscopy. A novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117

    Article  PubMed  Google Scholar 

  2. Reddy N, Rao P. Per oral transgastric endoscopic appendectomy in human. Paper presented at 45th Annual Conference of Gastrointestinal Endoscopy of India, Jaipur, India, February 28–29, 2004

  3. Kantsevoy SV, Hu B, Jagannath SB et al (2006) Transgastric endoscopic splenectomy: is it possible? Surg Endosc 20:522–525

    Article  CAS  PubMed  Google Scholar 

  4. Pai RD, Fong DG, Bundga ME et al (2006) Transcolonic endoscopic cholecystectomy : a NOTES survival study in a porcine model. Gastrointest Endosc 64:428–434

    Article  PubMed  Google Scholar 

  5. Lima E, Rolanda C, Pego JM et al (2006) Transvesical endoscopic peritoneoscopy. A novel 5 mm port for intra-abdominal scarless surgery. J Urol 176:802–805

    Article  PubMed  Google Scholar 

  6. Lima E, Rolanda C, Correia-Pinto J (2008) Transvesical endoscopic peritoneoscopy: intra-abdominal scarless surgery for urologic applications. Curr Urol Rep 9:50–54

    Article  PubMed  Google Scholar 

  7. Perretta S, Sereno S, Forgione A et al (2007) A new method to close the gastrotomy by using a cardiac septal occluder: long-term survival study in a porcine model. Gastrointest Endosc 66:809–813

    Article  PubMed  Google Scholar 

  8. Astudillo JA, Sporn E, Bachman S et al (2008) Transluminal endoscopic cholecystectomy: changing the paradigm. Eur Surg 40:111–116

    Article  Google Scholar 

  9. Pearl JP, Ponsky JL (2007) Natural orifice transluminal endoscopic surgery: past, present and future. J Min Access Surg 3:43–46

    Article  Google Scholar 

  10. Pearl JP, Ponsky JL (2008) Natural orifice translumenal endoscopic surgery: a critical review. J Gastrointest Surg 12:1293–1300

    Article  PubMed  Google Scholar 

  11. Gordts S, Puttemans P, Sy G (2005) Transvaginal laparoscopy. Best Pract Res Clin Obstet Gynaecol 19:757–767

    Article  CAS  PubMed  Google Scholar 

  12. Tsin DA, Sequeria RJ, Giannikas G (2001) Culdolaparoscopy : a preliminary report. JSLS 5:69–71

    CAS  PubMed  Google Scholar 

  13. Tsin DA, Sequeria RJ, Giannikas G (2003) Culdolaparoscopic cholecystectomy during vaginal hysterectomy. JSLS 7:171–172

    PubMed  Google Scholar 

  14. Marescaux J, Dallemagne B, Perretta S et al (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142:823–826

    Article  PubMed  Google Scholar 

  15. Bessler M, Stevens PD, Milone L (2007) Transvaginal laparoscopically assisted endoscocpic cholecystectomy: a hybrid approach to natural orifice surgery. Gastrointest Endosc 66:1243–1245

    Article  PubMed  Google Scholar 

  16. Zorron R, Maggioni LC, Pombo L et al (2008) NOTES transvaginal cholecystectomy : a preliminary clinical application. Surg Endosc 22:542–547

    Article  CAS  PubMed  Google Scholar 

  17. Zornig C, Mofid H, Emmermann A (2008) Scarles cholecystectomy with combined transvaginal and transumbilical approach in a series of 20 patients. Surg Endosc 22:1427–1429

    Article  CAS  PubMed  Google Scholar 

  18. Forgione A, Maggioni D, Sansonna F et al (2008) Transvaginal endoscopic cholecystectomy in human beings: preliminary results. J Laparoendosc Adv Surg Tech 18:345–351

    Article  Google Scholar 

  19. De Carli L, Zorron R, Branco A et al (2008) Natural orifice translumenal endoscopic surgery (NOTES). Transvaginal cholecystectomy in a morbidly obese patient. Obes Surg 18:886–889

    Article  Google Scholar 

  20. Sodergren MH, Clark J, Athanasiou T et al (2009) Natural orifice translumenal endoscopic surgery : critical appraisal of applications in clinical practice. Surg Endosc 23:680–687

    Article  PubMed  Google Scholar 

  21. Rohatgi A, Widdison AL (2006) An audit of cystic duct closure in laparoscopic cholecystectomies. Surg Endosc 20:875–877

    Article  CAS  PubMed  Google Scholar 

  22. Kinoshita T, Kanehira E, Omura K et al (1999) Experimental study on heat production by a 23.5 kHz ultrasonically activated device for endoscopic surgery. Surg Endosc 13:621–625

    Article  CAS  PubMed  Google Scholar 

  23. Capelluto E, Champault G (2000) Variations de la temperature intrapéritonéale au cours de la cholécystectomie laparoscopique. Ann Chir 125:259–262

    Article  CAS  PubMed  Google Scholar 

  24. Benevento A, Boni L (2005) New technologies in minimally invasive surgery. Chapter 11. In: Farinon A (ed) Endoscopic surgery of the potential anatomical spaces. Springer, The Netherlands, pp 131–145

    Chapter  Google Scholar 

  25. Perko Z, Pogorelic K, Tomic S et al (2006) Lateral thermal damage to rat abdominal wall after harmonic scalpel application. Surg Endosc 20:322–324

    Article  CAS  PubMed  Google Scholar 

  26. Klinger CH, Remzi M, Marberger M et al (2006) Haemostasis in laparoscopy. Eur Urol 50:948–957

    Article  Google Scholar 

  27. Janssen IMC, Swank DJ, Boonstra O et al (2003) Ultrasonic dissection versus electrocautery in laparoscopic cholecystectomy. Br J Surg 90:799–803

    Article  CAS  PubMed  Google Scholar 

  28. Leroy J, Cahill RA, Perretta S et al (2009) Natural orifice translumenal endoscopic surgery (NOTES) applied totally to sigmoidectomy: an original technique with survival in a porcine model. Surg Endosc 23:24–30 Epub 2006 Sep 24

    Article  PubMed  Google Scholar 

  29. Cahill RA, Perretta S, Forgione A et al (2009) Combined sentinel node biopsy and localized sigmoid resection entirely by natural orifice transluminal endoscopic surgery : a new challenge to the old paradigm. Dis Colon Rectum 52:725

    CAS  PubMed  Google Scholar 

  30. Ghezzi F, Raio L, Mueller MD et al (2002) Vaginal extraction of pelvic masses following operative laparoscopy. Surg Endosc 16:1691–1696

    Article  CAS  PubMed  Google Scholar 

  31. Clayton RD (2006) Hysterectomy. Best Pract Res Clin Obstet Gynaecol 20:73–76

    Article  CAS  PubMed  Google Scholar 

  32. Gordts S, Campo R, Puttemans P et al (2008) Transvaginal access: a safe technique for tubo-ovarian exploration in infertility? Review of the literature. Gynecol Surg 5:187–191

    Article  Google Scholar 

  33. Kovac SR (2000) Hysterectomy outcomes in patients with similar indications. Obstet Gynecol 95:787–793

    Article  CAS  PubMed  Google Scholar 

  34. Swanstrom LL, Kozarek R, Pasrischa PJ (2005) Development of a new access device for transgastric surgery. J Gastrointest Surg 9:1129–1136

    Article  PubMed  Google Scholar 

  35. Miedema BW, Astudillo JA, Sporn E et al (2008) NOTES techniques: present and future. Eur Surg 40:103–110

    Article  Google Scholar 

  36. Scott DJ, Tang SJ, Fernandez R et al (2007) Completely transvaginal NOTES cholecystectomy using magnetically anchored instruments. Surg Endosc 21:2308–2316

    Article  PubMed  Google Scholar 

  37. Rentschler ME, Dumpert J, Platt SR (2007) Natural orifice surgery with an endoluminal mobile robot. Surg Endosc 21:1212–1215

    Article  PubMed  Google Scholar 

  38. Swanstrom LL, Whiteford M, Khajanchee Y (2008) Developing essential tools to enable transgastric surgery. Surg Endosc 22:600–604 Epub 2007 Nov 1

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors sincerely thank Karl Storz (Tuttlingen, Germany) for their valuable technical support.

Author information

Authors and Affiliations

  1. General Surgery and Videolaparoscopy Unit, AIMS—Advanced International Mininvasive Surgery Academy, Niguarda Ca’ Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy

    Raffaele Pugliese, Antonello Forgione, Fabio Sansonna, Giovanni Carlo Ferrari, Stefano Di Lernia & Carmelo Magistro

Authors
  1. Raffaele Pugliese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonello Forgione
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabio Sansonna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giovanni Carlo Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefano Di Lernia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carmelo Magistro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raffaele Pugliese.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pugliese, R., Forgione, A., Sansonna, F. et al. Hybrid NOTES transvaginal cholecystectomy: operative and long-term results after 18 cases. Langenbecks Arch Surg 395, 241–245 (2010). https://doi.org/10.1007/s00423-009-0528-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-009-0528-2

Keywords

Search

Navigation