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Surgical Endoscopy

, Volume 25, Issue 6, pp 1822–1826 | Cite as

NOTES cholecystectomy: matched-pair analysis comparing the transvaginal hybrid and conventional laparoscopic techniques in a series of 216 patients

  • Carsten ZornigEmail author
  • Linn Siemssen
  • Alice Emmermann
  • Margrit Alm
  • Hans A. von Waldenfels
  • Conrad Felixmüller
  • Hamid Mofid
Article

Abstract

Background

Natural orifice transluminal endoscopic surgery (NOTES) is currently a very important topic for both gastroenterologists and surgeons. We have developed a technique of transvaginal hybrid NOTES cholecystectomy (TVC) that leaves no visible scar and is applicable to daily use. This technique is compared to the conventional laparoscopic cholecystectomy (CLC) in a matched-pair analysis.

Methods

From June 2007 until February 2009, 108 NOTES cholecystectomies were performed. For a matched-pair analysis we first selected a group of 192 female patients who had undergone CLC and who were operated on by the same group of surgeons in the same time period. Then 108 pairs who had TVC were matched according to the degree of inflammation of the gallbladder and age. We were able to contact 208 patients at least 3 months after surgery. Hence, the study analysis was performed with 100 complete pairs.

Results

All 200 cholecystectomies were performed successfully without conversion. The TVC procedure was significantly longer than CLC (52 vs. 35 min, p < 0.001). There were no intraoperative complications in either group. There were no significant differences with respect to reoperations, wound infections, consumption of analgesic drugs, length of hospital stay, and sick leave. Seventy-five TVC and 73 CLC patients had sexual intercourse after the operation without any complaints.

Conclusion

We present here the largest series of NOTES for cholecystectomy published to date and the first comparative study with the gold standard. The TVC technique is as successful as the CLC, it causes no more complications than CLC, especially with respect to the vaginal approach, it is more time-consuming to perform, but has an ideal cosmetic result, i.e., no visible scar.

Keywords

NOTES Transvaginal cholecystectomy Comparative study 

Notes

Acknowledgment

We thank Prof. Wegscheider and Dr. Treszl of the Institut für Biometrie und Epidemiologie, Universitätskrankenhaus Eppendorf, Hamburg, for their help in the statistical analysis of this study.

Disclosures

Prof. Zornig and Dres. Mofid, Siemssen, Emmermann, Alm, von Waldenfels, and Felixmüller have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Carsten Zornig
    • 1
    Email author
  • Linn Siemssen
    • 1
  • Alice Emmermann
    • 1
  • Margrit Alm
    • 1
  • Hans A. von Waldenfels
    • 2
  • Conrad Felixmüller
    • 2
  • Hamid Mofid
    • 1
  1. 1.Department of SurgeryIsraelitisches KrankenhausHamburgGermany
  2. 2.Praxisklinik Winterhude for Gynecology and ObstetricsHamburgGermany

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