Transvaginal video-assisted cholecystectomy in clinical practice
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Transvaginal video-assisted cholecystectomy with rigid instruments is a new procedure that combines natural orifice surgery (NOS) with classic laparoscopy. This hybrid technique requires conventional laparoscopy via an umbilical incision. To date it is unclear if this procedure is safe and feasible in routine practice.
We report on a case series of 128 women who consented to transvaginal cholecystectomy. Data, including visual analog scores (VAS), were collected prospectively via a standard digital spreadsheet. Patients completed satisfaction questionnaires within 10 days after discharge from hospital. We report on outcomes, age, body mass index, operating time, complications, pain scores, and patient satisfaction.
In 115 (89.8%) patients the procedure was performed as a transvaginal operation. In 11 women (8.6%), we converted to standard laparoscopy, and in 2 cases (1.6%), we converted to an open procedure. Mean age was 52.4 years (range = 23–78 years) and mean body mass index was 27.8 (range = 18.8–42). Mean operating time was 60.6 min (range = 22–110 min). Other procedures were combined with hybrid cholecystectomy in six cases. Complications following transvaginal access included one vaginal bleeding, one perforation of the urinary bladder, and one superficial lesion of the rectum. In one case the hepatic duct had to be stented due to leakage after the procedure via endoscopic retrograde cholangiography. Mean VAS on day 1 was 2.26 (±0.31 SEM) and on day 2 it was 1.53 (±0.35 SEM). In a postoperative questionnaire, 95% of patients indicated that they would recommend this procedure to other patients.
Transvaginal cholecystectomy is a safe and easy-to-learn procedure. Possible complications are different than those of standard laparoscopic procedures. Trauma to the abdominal wall and scarring is minimal. Postoperative pain scores were not different than those of standard laparoscopy and a high percentage of patients are satisfied with the procedure.
KeywordsCholecystectomy Gastrointestinal Endoscopy Complications Transvaginal NOS NOTES
We thank Mrs. V. Schulz (study nurse) for gathering data and supplying information to patients. Statistical advice came from Dr. B. Schicke, Berlin. Surgeons who performed transvaginal cholecystectomy included Dr. J. Burghardt, Dr. F. Fritze, Mr. M. Federlein, Dr. V. Müller, Dr. Y. Ahmadpour, Dr. D. Weiland, Mr. T. Martin, Dr. B. Hoz, Mrs. Y. Atas, Dr. O. Rückbeil, and Dr. B. Liersch. There was support from the Gynecology Department, including Dr. S. Gläser, Dr. A. Lippkowski, and Prof. Dr. D. Elling.
Mr. Matthias Federlein receives travel support from Karl Storz, Germany and course fees from Ethicon, Germany. He is a medical instructor for endoscopic training sponsored by Olympus, Germany. Dr. Dietmar Borchert receives travel support from Karl Storz, Germany. Dr. Verena Müller receives travel support from Karl Storz, Germany and Spain and course fees from Ethicon, Germany. Mrs. Yüksel Atas receives course fees from Ethicon, Germany. Dr. Frauke Fritze receives travel support from Ethicon, KCI, and Covidien, Germany. He is a medical instructor for surgical training sponsored by Nycomed, Covidien, and Karl Storz, Germany. Dr. Jens Burghardt receives travel support from Karl Storz and Covidien, Germany. Prof. Dr. Dirk Elling receives travel support and honoraria for lectures from GlaxoSmithKline, Novartis, and Cephalon, Germany. Prof. Dr. Klaus Gellert has no conflicts of interest or financial ties to disclose.
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