title: Routine cholangiography during rigid-hybrid transvaginal natural orifice transluminal endoscopic cholecystectomy.
abstract: BACKGROUND
  Transvaginal rigid-hybrid transluminal endoscopic cholecystectomy (tvCCE) has become a routine procedure in some laparoscopic departments in recent years. Although intraoperative cholangiography is an important adjunct to cholecystectomy, its feasibility and safety in tvCCE have not been demonstrated to date.
  
  
  METHODS
  Patients undergoing tvCCE between April and October 2012 were included in this study. An intraoperative cholangiogram was obtained routinely for all the patients. Patient characteristics, operation data, feasibility, and duration of the cholangiography as well as the postoperative course were recorded prospectively.
  
  
  RESULTS
  For 32 (97 %) of the 33 patients enrolled in this study, intraoperative cholangiography could be performed successfully. The median duration of cholangiography was 6 min (interquartile range, 4-7 min). Common bile duct stones were detected in three patients (10 %). Laparoscopic bile duct revision with the aid of one additional port was successful in two of these patients. One patient needed postoperative endoscopic retrograde cholangiopancreatography due to the impossibility of extracting an impacted prepapillary concrement. One operation was converted to a four-port laparoscopic cholecystectomy. One additional port was used in 11 patients (33 %) and two additional ports in three patients (9 %). Three intraoperative minor complications (9 %) and one postoperative minor complication (3 %) occurred.
  
  
  CONCLUSIONS
  Intraoperative cholangiography during tvCCE is feasible, safe, and easy to perform. The need for intraoperative cholangiography no longer represents a contraindication for tvCCE.
authors.affiliation: Department of Surgery, Kantonsspital Baselland, CH-4101, Bruderholz, Switzerland.
authors.forename: Onder
authors.initials: O
authors.lastname: Ogredici
authors.forename: Georg R
authors.initials: GR
authors.lastname: Linke
authors.forename: Sebastian
authors.initials: S
authors.lastname: Lamm
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosenthal
authors.forename: Andreas
authors.initials: A
authors.lastname: Zerz
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Steinemann
mesh_terms: D000328:Adult; D002758:Cholangiography / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000379:methods*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D019723:Endoscopes; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome; D014621:Vagina