title: Multimedia article: Transvaginal laparoscopic cholecystectomy: laparoscopically assisted.
abstract: Natural orifice transluminal endoscopic surgery (NOTES) is considered the new frontier for minimally invasive surgery. NOTES procedures such as peritoneoscopy, splenectomy, and cholecystectomy in animal models have been described. The aim of our experiment was to determine the feasibility and technical aspects of a new endoluminal surgical procedure. After approval from Columbia's IACUC, a transvaginal laparoscopically assisted endoscopic cholecystectomy was performed on four 30 kg Yorkshire pigs. The first step was to insert a 1.5 cm endoscope into the vagina under direct laparoscopic vision. Then the gallbladder was reached and, with the help of a laparoscopic grasper to hold up the gallbladder, the operation was performed. At the end of the procedure the gallbladder was snared out through the vagina attached to the endoscope. There were no intraoperative complications such as bleeding, common bile duct or endo-abdominal organ damage. Total operative time ranged between 110 and 155 min. Based on our experience in the porcine model, we believe that a transvaginal endoscopic cholecystectomy is feasible in humans.
authors.affiliation: Department of Surgery, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, Suite 620, New York, NY 10032, USA. mb28@columbia.edu
authors.forename: Marc
authors.initials: M
authors.lastname: Bessler
authors.forename: Peter D
authors.initials: PD
authors.lastname: Stevens
authors.forename: Luca
authors.initials: L
authors.lastname: Milone
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Hogle
authors.forename: Evren
authors.initials: E
authors.lastname: Durak
authors.forename: Dennis
authors.initials: D
authors.lastname: Fowler
mesh_terms: D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D023421:Models, Animal; D013552:Swine; D014621:Vagina