title: Hybrid transvaginal cholecystectomy, clinical results and patient-reported outcomes of 50 consecutive cases.
abstract: OBJECTIVE
  The aim of this study was to report the clinical and cosmetic results of transvaginal hybrid cholecystectomy (TVC).
  
  
  BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) has been developed as a minimal invasive alternative for conventional laparoscopic cholecystectomy. Although transvaginal NOTES procedures are becoming increasingly popular, data focussing on body image, cosmesis and sexual recovery are rare.
  
  
  METHODS
  Our clinic started to perform the TVC in the beginning of 2011. Female patients with symptomatic gallstone disease that were treated between January 2011 and April 2012 with TVC were entered in a prospective database. All patients received a survey postoperative with questions about recovery, cosmesis and body image.
  
  
  RESULTS
  Fifty consecutive patients were treated with a TVC. There were no major complications. Mean operative time was 61 min. In five patients (10 %), a conversion to another type of cholecystectomy was necessary. None of the sexually active women observed dyspareunia postoperative. The results for cosmesis and body image after the transvaginal approach were excellent.
  
  
  CONCLUSIONS
  TVC is a safe and feasible procedure when performed on selected patients. The transvaginal route seems to result in excellent cosmetic outcomes without gynaecologic complications after short-term follow up. Randomised trials are needed to specify the role of TVC in the treatment of patients with symptomatic gallstone disease and to detect differences in cosmetic outcomes.
authors.affiliation: Department of Surgery, Gelderse Vallei Hospital, Willy Brandtlaan 10, Postbus 9025, 6710 HN, Ede, the Netherlands. boezem@hotmail.com
authors.forename: Peter B
authors.initials: PB
authors.lastname: van den Boezem
authors.forename: Simone
authors.initials: S
authors.lastname: Velthuis
authors.forename: Harm J
authors.initials: HJ
authors.lastname: Lourens
authors.forename: Rahul A K
authors.initials: RA
authors.lastname: Samlal
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Cuesta
authors.forename: Colin
authors.initials: C
authors.lastname: Sietses
mesh_terms: D000293:Adolescent; D000328:Adult; D001828:Body Image; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D042882:Gallstones / Q000601:surgery; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery; D018579:Patient Selection; D011183:Postoperative Complications; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014621:Vagina