title: Video. Magnetic retraction for NOTES transvaginal cholecystectomy.
abstract: 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.
authors.affiliation: University of California, San Diego, CA, USA.
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
authors.forename: Yoav
authors.initials: Y
authors.lastname: Mintz
authors.forename: Garth R
authors.initials: GR
authors.lastname: Jacobsen
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Sandler
authors.forename: John P
authors.initials: JP
authors.lastname: Cullen
authors.forename: Adam
authors.initials: A
authors.lastname: Spivack
authors.forename: David W
authors.initials: DW
authors.lastname: Easter
authors.forename: Alana
authors.initials: A
authors.lastname: Chock
authors.forename: Michelle K
authors.initials: MK
authors.lastname: Savu
authors.forename: Sonia
authors.initials: S
authors.lastname: Ramamoorthy
authors.forename: Julie
authors.initials: J
authors.lastname: Bosia
authors.forename: Sanjay
authors.initials: S
authors.lastname: Agarwal
authors.forename: Emily
authors.initials: E
authors.lastname: Lukacz
authors.forename: Emily
authors.initials: E
authors.lastname: Whitcomb
authors.forename: Thomas
authors.initials: T
authors.lastname: Savides
authors.forename: Mark A
authors.initials: MA
authors.lastname: Talamini
mesh_terms: 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