title: Surgical outcome and midterm follow-up after transvaginal NOTES hybrid cholecystectomy: analysis of a prospective clinical series.
abstract: BACKGROUND
  In the last 3 years transvaginal hybrid cholecystectomy (TV-ChE) has gained widespread interest as a potential alternative to laparoscopic cholecystectomy. However, substantial doubts about the transvaginal access and possibly associated complaints and complications have been raised.
  
  
  METHODS
  This was a prospective clinical series of 80 consecutive female patients, nonrandomly chosen and without a control group, who underwent a TV-ChE. All patients were evaluated with special regard to outcome data such as surgical complications and gynecological complaints. Perioperative clinical data were collected and a gynecological examination was performed 3 weeks after surgery as well as a follow-up survey 3 months after surgery.
  
  
  RESULTS
  The TV-ChE was performed in all patients without conversion to laparoscopy or open surgery. Two surgical complications occurred (1 urinary bladder injury and 1 case of bleeding). No infections of the surgical wound or any other complications were seen in the gynecological follow-up examination 3 weeks after the operation. After a follow-up of 3 months, 4% of the patients under 50 years of age reported slight and temporary problems after transvaginal cholecystectomy (dyspareunia and episodes of unclear lower abdominal pain), whereas such phenomena were seen in about 9% of women over 50 years of age (P < .05). A 33-year-old woman became pregnant 3 weeks after the operation.
  
  
  CONCLUSIONS
  TV-ChE is a safe and less invasive surgical technique. Doubts about this operating technique with regard to an increased risk of infection or surgical complications as well as subsequent gynecological problems seem to be unfounded.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Park-Klinik-Weissensee, Berlin, Germany. hensel@park-klinik.com
authors.forename: Mario
authors.initials: M
authors.lastname: Hensel
authors.forename: Utz
authors.initials: U
authors.lastname: Schernikau
authors.forename: Axel
authors.initials: A
authors.lastname: Schmidt
authors.forename: Georg
authors.initials: G
authors.lastname: Arlt
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina; D055815:Young Adult