title: Feasibility and safety of functional cholecystectomy by pure NOTES: a pilot animal study.
abstract: BACKGROUND
  NOTES cholecystectomy has become one of the hottest areas of research. But most of the cases need the assistance of the laparoscope. This study is conducted to evaluate the feasibility and safety of a newly proposed operative method-functional cholecystectomy by pure NOTES.
  
  
  METHODS
  The functional cholecystectomy was performed on eight female miniature pigs. An incision was made on the vaginal wall, and an endoscope was inserted into the peritoneal cavity to create a pneumoperitoneum to expose the intra-abdominal viscera, gallbladder, and cystic duct. The cystic duct was isolated and closed with a clip. Then, an injection needle was inserted into the gallbladder to suck up the bile. After the gallbladder was washed with saline, an incision was made on the wall of the gallbladder, and the tip of the endoscope was inserted into the gallbladder cavity. After the endoscope was withdrawn, the gallbladder incision was closed with clips in four pigs and was suspended in the other four pigs. The vaginal incision was closed with clips. All the animals were closely monitored and euthanized 28 days after the procedure. Necropsy was performed.
  
  
  RESULTS
  The functional cholecystectomy was successfully completed in all eight pigs. No severe intraoperative complications occurred. The animals recovered well postoperatively. At necropsy, no macroscopic signs of intraperitoneal infection or bile leakage in the peritoneal cavity were observed, and the clips were still present on the cystic duct in a good position in all cases. The gallbladder incision healed, with no sign of bile leakage or injury to the adjacent organs.
  
  
  CONCLUSIONS
  We successfully performed the functional cholecystectomy by transvaginal approach on pigs, which appears to be feasible, safe, and convenient. Functional cholecystectomy provides a new fitting path to pure NOTES.
authors.affiliation: Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Bing-Rong
authors.initials: BR
authors.lastname: Liu
authors.forename: Ling-Jian
authors.initials: LJ
authors.lastname: Kong
authors.forename: Ji-Tao
authors.initials: JT
authors.lastname: Song
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Heng
authors.initials: H
authors.lastname: Yu
authors.forename: Qin-Fa
authors.initials: QF
authors.lastname: Dou
mesh_terms: D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041761:Cholecystolithiasis / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D057605:Natural Orifice Endoscopic Surgery; D013552:Swine; D013556:Swine, Miniature; D014621:Vagina