NOTES transvaginal hybrid cholecystectomy: the United States human experience.
BACKGROUND
"Pure" NOTES and "hybrid" NOTES procedures have gained popularity during the past few years. However, most of these published series have been documented outside the United States.


METHODS
This is a prospective, nonrandomized series of patients. Female subjects who presented to the University of California at San Diego surgery clinic for elective cholecystectomy were offered participation in this study. Patients met the following criteria: aged 18-75 years; diagnosis of gallbladder disease that required cholecystectomy and American Society of Anesthesiology (ASA) class 1. Hybrid NOTES transvaginal technique was used for cholecystectomy.


RESULTS
A total of 27 women underwent hybrid transvaginal NOTES cholecystectomy during a 43-month period. The median age was 40.1 (range 23-63) years. The mean body mass index was 25.2 (range 16.4-34.1). All patients had an ASA I-II classification. The mean operative time was 92 (range 38-165) min. There was no conversion to an open operation. The mean hospital stay was 1.07 (range 1-2) days. Patients were followed for a mean of 3.32 (range 0.06-12.2) months. There were no postoperative complications. No scars were visible on the abdominal wall.


CONCLUSIONS
This study is the largest series of hybrid transvaginal cholecystectomy published in the United States. With our experience, we demonstrate that this technique is safe and clinically viable.
Center for the Future of Surgery, University of California at San Diego, San Diego, CA, USA. snijhawan@usouthal.edu
Sheetal
S
Nijhawan
Juan S
JS
Barajas-Gamboa
Saniea
S
Majid
Garth R
GR
Jacobsen
Michael F
MF
Sedrak
Bryan J
BJ
Sandler
Mark A
MA
Talamini
Santiago
S
Horgan
D000328:Adult; D002763:Cholecystectomy / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D011446:Prospective Studies; D014481:United States; D014621:Vagina; D055815:Young Adult