title: First Croatian transvaginal laparoscopically assisted cholecystectomies.
abstract: OBJECTIVE
  The aim of this study was to determine the feasibility and technical aspects of a new endoluminal surgical procedure: transvaginal laparoscopically assisted endoscopic cholecystectomy.
  
  
  METHODS
  Three female patients underwent transvaginal laparoscopically assisted endoscopic cholecystectomy (aged 40, 61 and 33 years). Pneumoperitoneum was created through a 5mm supraumbilical incision. Through the posterior fornix of the vagina the second 10mm trocar, laparoscope and 5mm laparoscopic grasper were introduced. The gallbladder was dissected using standard 5mm laparoscopic grasper, hook, electrocoagulation and harmonic shears introduced supraumbilically. The dissected gallbladder was removed in a specimen retrieval bag.
  
  
  RESULTS
  Transvaginal laparoscopically assisted endoscopic cholecystectomy was feasible in all patients. No intraoperative or postoperative complications were observed and there was no need for extra-umbilical skin incisions. Total operative time ranged between 60 and 75 minutes. Median length of hospital stay was 1 day.
  
  
  CONCLUSIONS
  This was the first clinical application of transvaginal laparoscopically assisted cholecystectomy in Croatia. The initial clinical application of this technique in 3 female patients was feasible, effective and safe when performed by experienced laparoscopic surgeons using standard laparoscopic instruments.
authors.affiliation: Department of Surgery, University Hospital and School of Medicine Split, Croatia. zperko@kbsplit.hr
authors.forename: Zdravko
authors.initials: Z
authors.lastname: Perko
authors.forename: Zoran
authors.initials: Z
authors.lastname: Cala
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Mimica
authors.forename: Rade
authors.initials: R
authors.lastname: Stipić
authors.forename: Tonka
authors.initials: T
authors.lastname: Bakotin
authors.forename: Jasenka
authors.initials: J
authors.lastname: Kraljević
authors.forename: Vedran
authors.initials: V
authors.lastname: Radonić
authors.forename: Tomislav
authors.initials: T
authors.lastname: Strinić
authors.forename: Ivana Alujević
authors.initials: IA
authors.lastname: Jakus
authors.forename: Miroslav
authors.initials: M
authors.lastname: Simunić
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D017523:Croatia; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020706:Laparoscopes; D007902:Length of Stay; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation; D011028:Pneumoperitoneum, Artificial; D013997:Time Factors; D016896:Treatment Outcome; D014621:Vagina