title: New hybrid approach for NOTES transvaginal cholecystectomy: preliminary clinical experience.
abstract: OBJECTIVE
  Natural orifice translumenal endoscopic surgery (NOTES) represents the first step toward scar-less surgery. The objective of this study is to evaluate early clinical results of transvaginal cholecystectomy using a new technique.
  
  
  METHODS
  Institutional review board approval was obtained and transvaginal NOTES cholecystectomy was performed in 12 women for cholelithiasis. A 2-channel videoendoscope was inserted in the abdominal cavity through a posterior colpotomy. Two 3-mm trocars were inserted deep in the umbilicus, and a 10-mm trocar was placed through the colpotomy parallel to the endoscope. Dissection was performed with endoscopic instruments combined with 3-mm laparoscopic instruments.
  
  
  RESULTS
  Mean operative time was 125.8 minutes. All procedures occurred without intraoperative complications or conversions, except for 1 vulvar laceration. There were no postoperative complications in the clinical follow-up.
  
  
  CONCLUSIONS
  Transvaginal NOTES is a feasible and safe alternative for cholecystectomy in this preliminary clinical experience, allowing good cosmetic benefits and low analgesic requirement.
authors: Department of Surgery, Hospital Irmandade Santa Casa da Misericordia Porto Alegre, Porto Alegre, Brazil. luizdecarli@vanet.com.br
authors: Luiz Alberto
authors: LA
authors: Decarli
authors: Ricardo
authors: R
authors: Zorron
authors: Alcides
authors: A
authors: Branco
authors: Fernando Cirme
authors: FC
authors: Lima
authors: Marcos
authors: M
authors: Tang
authors: Sergio Ricardo
authors: SR
authors: Pioneer
authors: José Inácio
authors: JI
authors: Sanseverino
authors: Rodrigo
authors: R
authors: Menguer
authors: André Vicente
authors: AV
authors: Bigolin
authors: Michel
authors: M
authors: Gagner
mesh_terms: D015992:Body Mass Index; D002763:Cholecystectomy / Q000379:methods*; D002769:Cholelithiasis / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D020884:Colpotomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D013536:Suture Techniques; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery; D014621:Vagina / Q000601:surgery*