Hybrid natural orifice transluminal endoscopic cholecystectomy: prospective human series.
BACKGROUND
Natural orifice transluminal endoscopic surgery (NOTES) makes it possible to perform intraperitoneal surgical procedures with a minimal number of access points in the abdominal wall. Currently, it is not possible to perform these interventions without the help of abdominal wall entryways, so these procedures are hybrids fusing minilaparoscopy and transluminal endoscopic surgery. This report presents a prospective clinical series of 25 patients who underwent transvaginal hybrid cholecystectomy for cholelithiasis.


METHODS
The study comprised a clinical series of 25 consecutive nonrandomized women who underwent a fusion transvaginal NOTES and minilaparoscopy procedure with two trocars for cholelithiasis: one 5-mm umbilical trocar and one 3-mm trocar in the upper left quadrant. The study had no control group.


RESULTS
The scheduled surgical intervention was performed for all 25 women. No intraoperative complications occurred. One patient had mild hematuria that resolved in less than 12 h, but no other complications occurred during an average follow-up period of 140 days. Of the 25 women, 20 were discharged in 24 h, and 5 were discharged less than 12 h after the procedure.


CONCLUSIONS
Hybrid transvaginal cholecystectomy, combining NOTES and minilaparoscopy, is a good surgical model for minimally invasive surgery. It can be performed in surgical settings where laparoscopy is practiced regularly using the instruments normally used for endoscopy and laparoscopic surgery. Due to the reproducibility of the intervention and the ease of vaginal closure, hybrid transvaginal cholecystectomy will permit further development of NOTES in the future.
Surgery and Gastroenterology Department, Hospital Son Llàtzer, Palma de Mallorca, Spain. acuadrad@gmail.com
Angel
A
Cuadrado-Garcia
Jose F
JF
Noguera
Jose M
JM
Olea-Martinez
Rafael
R
Morales
Carlos
C
Dolz
Luis
L
Lozano
Jose-Carlos
JC
Vicens
Juan José
JJ
Pujol
D000328:Adult; D002763:Cholecystectomy / Q000295:instrumentation / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D016896:Treatment Outcome; D014621:Vagina