[Training design and improvement of technical skills in the transvaginal cholecystectomy (NOTES)].
BACKGROUND
The current surgical scenario of the surgery through natural orifices or <<no-scar surgery>> requires acquiring new technical skills by the surgeon. We introduce the initial experience of the Minimally Invasive Surgery Centre Jesús Usón (MISCJU) in the design and setting-up of a surgical training programme using the the natural orifices approach for the acquisition of surgical skills and abilities, based on the preliminary trials in simulators and a pig model.


METHODS
After initial training, using a laparoscopic pelvic-trainer, 7 female pigs, with weights between 35-40 kg, were operated on. The transvaginal approach was completed using a one-channel gastroscope in all the animals. After accessing the abdomen, the abdominal cavity was explored, and the surgery was concluded with the endoscopic cholecystectomy.


RESULTS
Endoscopic cholecystectomy was successfully completed in 6 cases. In one of the animals, the procedure was stopped because of technical problems regarding the endoscope leaning to one end. The average surgical time was 107.14 min (range, 80-150 min). The transvaginal approach enabled the abdominal to be explored and the dissection, ligature and section of the cystic duct and the cystic artery. After cholecystectomy, the gallbladder was extracted through the vagina. After the procedure necropsy did not reveal intra-abdominal lesions or intraoperative complications.


CONCLUSIONS
The pure transvaginal cholecystectomy is a feasible and reproducible procedure in the animal model. A systematized training model, which includes physiopathology knowledge as well as technical knowledge, in order to translate these procedures to the clinical practice in a safe way, is needed.
Centro de Cirugía de Mínima Invasión Jesús Usón, Cáceres, España. msanchez@ccmijesususon.com
Francisco Miguel
FM
Sánchez-Margallo
José Manuel
JM
Asencio Pascual
María
M
Del Carmen Tejonero Alvarez
Miguel Angel
MA
Sánchez Hurtado
Francisco Julián
FJ
Pérez Duarte
Jesús
J
Usón Gargallo
Salvador Pascual
SP
Sánchez-Gijón
D000818:Animals; D002763:Cholecystectomy / Q000193:education* / Q000379:methods*; D005260:Female; D013552:Swine; D014621:Vagina