title: NOTES cholecystectomy: matched-pair analysis comparing the transvaginal hybrid and conventional laparoscopic techniques in a series of 216 patients.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) is currently a very important topic for both gastroenterologists and surgeons. We have developed a technique of transvaginal hybrid NOTES cholecystectomy (TVC) that leaves no visible scar and is applicable to daily use. This technique is compared to the conventional laparoscopic cholecystectomy (CLC) in a matched-pair analysis.
  
  
  METHODS
  From June 2007 until February 2009, 108 NOTES cholecystectomies were performed. For a matched-pair analysis we first selected a group of 192 female patients who had undergone CLC and who were operated on by the same group of surgeons in the same time period. Then 108 pairs who had TVC were matched according to the degree of inflammation of the gallbladder and age. We were able to contact 208 patients at least 3 months after surgery. Hence, the study analysis was performed with 100 complete pairs.
  
  
  RESULTS
  All 200 cholecystectomies were performed successfully without conversion. The TVC procedure was significantly longer than CLC (52 vs. 35 min, p<0.001). There were no intraoperative complications in either group. There were no significant differences with respect to reoperations, wound infections, consumption of analgesic drugs, length of hospital stay, and sick leave. Seventy-five TVC and 73 CLC patients had sexual intercourse after the operation without any complaints.
  
  
  CONCLUSIONS
  We present here the largest series of NOTES for cholecystectomy published to date and the first comparative study with the gold standard. The TVC technique is as successful as the CLC, it causes no more complications than CLC, especially with respect to the vaginal approach, it is more time-consuming to perform, but has an ideal cosmetic result, i.e., no visible scar.
authors.affiliation: Department of Surgery, Israelitisches Krankenhaus, Orchideenstieg 14, 22297, Hamburg, Germany, zornig@ik-h.de.
authors.forename: Carsten
authors.initials: C
authors.lastname: Zornig
authors.forename: Linn
authors.initials: L
authors.lastname: Siemssen
authors.forename: Alice
authors.initials: A
authors.lastname: Emmermann
authors.forename: Margrit
authors.initials: M
authors.lastname: Alm
authors.forename: Hans A
authors.initials: HA
authors.lastname: von Waldenfels
authors.forename: Conrad
authors.initials: C
authors.lastname: Felixmüller
authors.forename: Hamid
authors.initials: H
authors.lastname: Mofid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D016555:Matched-Pair Analysis; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult