title: Less pain after transvaginal/transumbilical cholecystectomy than after the classical laparoscopic technique: short-term results of a matched-cohort study.
abstract: BACKGROUND
  Natural orifice surgery (NOS) is gaining acceptance as an alternative to the traditional laparoscopic technique, especially for cholecystectomy through the transvaginal route. However, NOS remains controversial concerning expected advantages in terms of short- and long-term outcomes and potential side effects. This study was designed to compare short-term outcomes between transvaginal/transumbilical and classical laparoscopic cholecystectomy (LC).
  
  
  METHODS
  A prospective matched-cohort study compared the authors' first 50 transvaginal/transumbilical cholecystectomies (TVC) with a group of 50 classical LCs from the corresponding period matched in terms of age, body mass index, and American Society of Anesthesiology classification. In both groups, elective surgery was performed for symptomatic cholecystolithiasis. In the NOS group, a hybrid procedure was performed with one transumbilical rigid instrument and two transvaginal rigid instruments. A numeric rating scale was used for daily pain assessment, initiated postoperatively in the recovery room. Both groups were compared with regard to length of surgery, intra- and postoperative complications, length of hospital stay, postoperative pain, and consumption of analgesics.
  
  
  RESULTS
  The length of surgery and the rate of complications were similar in the two groups. But significant advantages were found for the transvaginal access in terms of pain using Numeric Rating Scale (NRS) on the day of surgery (NRS, 1.5/10 vs 3.1/10; p = 0.003) as well as in the morning (NRS, 1.9/10 vs 2.8/10; p = 0.047) and in the evening (NRS, 1.1/10 vs 1.8/10; p = 0.025) of postoperative day 1, and with regard to the length of the postoperative hospital stay (2.7 vs 3.4 days; p = 0.035).
  
  
  CONCLUSIONS
  The findings show that TVC is a safe procedure for female patients. It has a risk comparable with that of classic LC, causes significantly less pain in the early postoperative period, and leads to a significantly shorter hospital stay. Prospective randomized trials are necessary to confirm these results.
authors.affiliation: Department of Abdominal, Vascular, and Transplant Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109 Cologne, Germany. buliand@kliniken-koeln.de
authors.forename: Dirk Rolf
authors.initials: DR
authors.lastname: Bulian
authors.forename: Linda
authors.initials: L
authors.lastname: Trump
authors.forename: Jürgen
authors.initials: J
authors.lastname: Knuth
authors.forename: Robert
authors.initials: R
authors.lastname: Siegel
authors.forename: Axel
authors.initials: A
authors.lastname: Sauerwald
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ströhlein
authors.forename: Markus Maria
authors.initials: MM
authors.lastname: Heiss
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D010149:Postoperative Pain / Q000453:epidemiology*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014472:Umbilicus; D014621:Vagina; D055815:Young Adult