title: Technical feasibility of totally natural orifice cholecystectomy in a swine model.
abstract: The goal of this study was to evaluate the feasibility of totally NOTES performing a cholecystectomy without laparoscopic assistance. A gastroscope was used through a transvaginal access in five acute female pigs. An incision of 2 cm was created in the vagina and pneumoperitoneum was obtained with a Veress needle. The gallbladder was located in the abdominal cavity using endoscopic transillumination for spatial orientation. After the abdominal suspension of the gallbladder the cholecystectomy was completed with the NOTES technique in four animals without complications. In one animal we had technical problems and the procedure was stopped. The mean operative time was 110 minutes. The transvaginal approach provides complete abdominal exploration and both the cystic duct and artery were identified, clipped, and transected. After dissection the gallbladder was removed through the vagina. Our results showed that completely transvaginal NOTES cholecystectomy is a feasible technique performed only with a flexible endoscope.
authors.affiliation: Minimally Invasive Surgery Centre Jesus Uson, Caceres, Spain. msanchez@ccmijesususon.com
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Sánchez-Margallo
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Asencio
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Tejonero
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Pérez
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Sánchez
authors.forename: Jesús
authors.initials: J
authors.lastname: Usón
authors.forename: Salvador
authors.initials: S
authors.lastname: Pascual
mesh_terms: D000818:Animals; D002763:Cholecystectomy / Q000379:methods*; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods*; D005260:Female; D023421:Models, Animal; D013552:Swine; D013997:Time Factors; D014621:Vagina / Q000601:surgery