title: NOTES: Transvaginal endoscopic cholecystectomy in humans-preliminary report of a case series.
abstract: OBJECTIVE
  Natural orifice translumenal endoscopic surgery (NOTES) represents an emerging technology, including under its umbrella a variety of approaches and combinations. The transvaginal approach to endoscopic cholecystectomy is one such technique, which we present here as a small series.
  
  
  METHODS
  From May to November 2007, a total of eight patients were scheduled to undergo transvaginal endoscopic cholecystectomy at our institute. Two patients were excluded as they were converted to laparoscopy due to technical difficulties.
  
  
  RESULTS
  Average age of the patients was 34.5 years, and mean body mass index was 27 kg/m(2). The mean operating time was 148.5 min. Patients were discharged in an average of four postoperative days. The major complication rate was 16% (1/6). The patient with a major complication had a subhepatic collection that was managed with ultrasonogram-guided aspiration followed by ERCP and stenting.
  
  
  CONCLUSIONS
  Since the first description of NOTES, there has been no standardized technique. In our technique, we used a single 3-mm trocar for visualizing the entry and exit of the endoscope, maintaining and measuring pneumoperitoneum, and retracting the gall bladder fundus. The instruments that were used were the conventional endoscopic ones. The transvaginal approach seems to be a viable alternative to the transgastric approach for cholecystectomy, as the transgastric approach has certain inherent problems like leakage from the gastrotomy site and poor ergonomy. The downside to the transvaginal approach is that it is possible only in women.
authors.affiliation: GEM Hospital & Postgraduate Institute, Coimbatore, India. drcp@gemhospital.net
authors.forename: Chinnusamy
authors.initials: C
authors.lastname: Palanivelu
authors.forename: Pidigu Seshiyer
authors.initials: PS
authors.lastname: Rajan
authors.forename: Muthukumaran
authors.initials: M
authors.lastname: Rangarajan
authors.forename: Mohan
authors.initials: M
authors.lastname: Prasad
authors.forename: Vijayan
authors.initials: V
authors.lastname: Kalyanakumari
authors.forename: Ramakrishnan
authors.initials: R
authors.lastname: Parthasarathi
authors.forename: Palanisamy
authors.initials: P
authors.lastname: Senthilnathan
mesh_terms: D000328:Adult; D002763:Cholecystectomy / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014621:Vagina