title: Transvaginal NOTES hybrid cholecystectomy.
abstract: BACKGROUND
  Initial reports confirm the safety and feasibility of natural orifice transluminal eendoscopic surgery (NOTES) transvaginal hybrid cholecystectomy (TVC). Benefits of TVC include no visible scars, less pain, and shorter recovery. The authors describe a single surgeon's initial experience with TVC through his first 20 cases.
  
  
  METHODS
  Under direct visualization from a 5-mm umbilical trochar, a 12-mm trocar, or in 2 cases a SILS port was introduced through the posterior vagina into the cul-de-sac. The gallbladder was visualized using an endoscope introduced through the vaginal port. Using extracorporeal stay sutures for retraction, the cystic duct and artery were dissected free, clipped, and divided. The gallbladder was then removed through the vaginal port.
  
  
  RESULTS
  Twenty patients underwent a successful TVC. The average age was 34.9 years (21-55 years), average body mass index was 29.9 kg/m2 (18.3-38.1 kg/m2), and the mean operative time was 71.4 minutes (42-116 minutes).
  
  
  CONCLUSIONS
  TVC is a safe, feasible, and attractive alternative to traditional 4-port laparoscopic cholecystectomy.
authors.affiliation: Yale University School of Medicine, Section of gastrointestinal surgery, New Haven, CT 06510, USA. kurt.roberts@yale.edu
authors.forename: Kurt E
authors.initials: KE
authors.lastname: Roberts
authors.forename: Shohan
authors.initials: S
authors.lastname: Shetty
authors.forename: Amir Hafeez
authors.initials: AH
authors.lastname: Shariff
authors.forename: Dan-Arin
authors.initials: DA
authors.lastname: Silasi
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Duffy
authors.forename: Robert L
authors.initials: RL
authors.lastname: Bell
mesh_terms: D000328:Adult; D002763:Cholecystectomy / Q000379:methods*; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011446:Prospective Studies; D014621:Vagina / Q000601:surgery*