Video. Magnetic retraction for NOTES transvaginal cholecystectomy.
BACKGROUND
Natural orifice translumenal endoscopic surgery (NOTES) has the potential to decrease the burden of an operation on a patient. Limitations of the endoscopic platform require innovative solutions to provide retraction and create an operation comparable with the gold standard, laparoscopic cholecystectomy.


METHODS
Four patients underwent transvaginal cholecystectomy. All procedures were performed under laparoscopic vision to ensure safety. The endoscope and a long articulating RealHand instrument were placed via a 15-mm vaginal trocar. A magnetic retraction system was used to retract the gallbladder safely. Laparoscopic clips were used to ligate the cystic duct and artery. All four gallbladders were successfully removed. No complications occurred. The mean operating time was 102 min.


RESULTS
All four procedures were completed without complications. The four patients all were discharged shortly after surgery and reported normal sexual activity without pain.


CONCLUSIONS
Transvaginal cholecystectomy can be completed safely using current technology. Further studies are needed to determine the safety of the procedure and to determine whether it confers any benefits other than cosmesis.
Horgan
Santiago
S
University of California, San Diego, CA, USA.
Mintz
Yoav
Y
Jacobsen
Garth R
GR
Sandler
Bryan J
BJ
Cullen
John P
JP
Spivack
Adam
A
Easter
David W
DW
Chock
Alana
A
Savu
Michelle K
MK
Ramamoorthy
Sonia
S
Bosia
Julie
J
Agarwal
Sanjay
S
Lukacz
Emily
E
Whitcomb
Emily
E
Savides
Thomas
T
Talamini
Mark A
MA
D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D008280:Magnetics; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D014621:Vagina / Q000601:surgery