title: Hybrid transvaginal cholecystectomy, NOTES, and minilaparoscopy: analysis of a prospective clinical series.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) makes it possible to perform intraperitoneal surgical procedures with a minimal number of access points in the abdominal wall. It is not yet possible to perform these interventions without the help of abdominal wall entryways, so these procedures are hybrids, a fusion of minilaparoscopy and transluminal endoscopic surgery. In this paper we present a prospective clinical series of 15 patients who underwent transvaginal hybrid cholecystectomy for cholelithiasis.
  
  
  METHODS
  This was a prospective clinical series of 15 consecutive female patients, nonrandomly chosen and without a control group, who underwent a fusion transvaginal NOTES and minilaparoscopy procedure with two entryways for cholelithiasis. One was umbilical and measured 5 mm in diameter, and the other was in the right upper quadrant and measured 3 mm in diameter.
  
  
  RESULTS
  The scheduled surgical intervention was performed on the 15 patients in whom it had been indicated. There were no intraoperative complications. One patient had mild hematuria that resolved in less than 12 h; there were no other complications after average follow-up of 124 days. Nine patients were discharged in 24 h, and two were discharged less than 12 h after the procedure.
  
  
  CONCLUSIONS
  Hybrid transvaginal cholecystectomy is a good surgical model for minimally invasive surgery, a combination of NOTES and minilaparoscopy. It can be performed in surgical settings where laparoscopy is practised regularly, using the instruments normally used for endoscopy and laparoscopic surgery. Owing to the reproducibility of the intervention and the ease of vaginal closure, hybrid transvaginal cholecystectomy will permit further development of NOTES in the future.
authors.affiliation: Cirugía General, Hospital Son Llàtzer, Palma, Spain. jnoguera@hsll.es
authors.forename: José
authors.initials: J
authors.lastname: Noguera
authors.forename: Carlos
authors.initials: C
authors.lastname: Dolz
authors.forename: Angel
authors.initials: A
authors.lastname: Cuadrado
authors.forename: José
authors.initials: J
authors.lastname: Olea
authors.forename: Angels
authors.initials: A
authors.lastname: Vilella
authors.forename: Rafael
authors.initials: R
authors.lastname: Morales
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020706:Laparoscopes; D007902:Length of Stay; D008875:Middle Aged; D008904:Miniaturization; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina; D055815:Young Adult