Surgical Endoscopy

, Volume 32, Issue 11, pp 4632–4638 | Cite as

Does obesity influence the results in Transvaginal Hybrid-NOTES cholecystectomy?

  • Dirk R. BulianEmail author
  • Jurgen Knuth
  • Panagiotis Thomaidis
  • Anna Rieger
  • Claudia Simone Seefeldt
  • Jonas Lange
  • Jurgen Meyer
  • Michael A. Stroehlein
  • Markus M. Heiss



Morbidly obese patients are usually excluded from studies that compare Transvaginal Hybrid-NOTES Cholecystectomy (TVC) with traditional laparoscopic cholecystectomy. Therefore, these study results cannot necessarily be transferred to this group of patients. In this study, we have analyzed and compared the outcomes of the procedure with obese and non-obese patients.


Data from a prospectively maintained database were retrospectively analyzed. All the TVCs performed in our clinic since 2008 were divided into groups according to their body mass index (BMI). Within these groups, we evaluated the following outcome parameters: age, ASA classification, procedural time, number of percutaneous trocars, intra- and postoperative complications, and postoperative hospital stay. Additionally, the posthospital surgical and gynecological follow-up was evaluated for additional complications and patients with class III obesity were contacted to determine further parameters.


Six underweight, 76 normal weight, 72 overweight, 48 class I obesity, 15 class II obesity, and 20 class III obesity patients were analyzed. ASA classification (P < 0.001), procedural time (P < 0.001), and number of percutaneous trocars (P < 0.001) significantly increased with the BMI. By contrast, intra- and postoperative complications (P = 0.134 and P = 0.571), as well as postoperative hospital stay (P = 0.076) did not depend on the BMI. Neither did the classification according to Clavien/Dindo show a significant relation (P = 0.640). Lethality was zero. All posthospital gynecological follow-ups were inconspicuous. Telephone follow-up of class III obesity patients reached a rate of 85% after median 3.4 years. There were no additional complications or problems during sexual intercourse. The satisfaction with the cosmetic and the overall result was very high.


Although the results of existing studies including normal-weight or merely moderately obese patients can hardly be applied to morbidly obese patients, especially regarding procedural time and the number of percutaneous trocars, obesity should not be an exclusion criterion for TVC, regardless of its magnitude.


Transvaginal cholecystectomy Obesity NOTES Body mass index Complications 



The authors thank Prof. Rolf Lefering of the Institute for Research
in Operative Medicine, Witten/Herdecke University, Cologne,
Germany, for assistance in the statistical analysis of this study, Kimberly Rossbach, Dallas, Texas, USA, Michaela Munk, Witten/Herdecke University, Witten, Germany, and Prof. Thomas Banchoff, Georgetown University, Washington D.C., USA, for proofreading.

Compliance with ethical standards


Drs. Dirk Rolf Bulian, Jurgen Knuth, Panagiotis Thomaidis, Anna Rieger, Claudia Simone Seefeldt, Jonas Lange, Jurgen Meyer, Michael Alfred Stroehlein, and Markus Maria Heiss have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Dirk R. Bulian
    • 1
    Email author
  • Jurgen Knuth
    • 1
    • 2
  • Panagiotis Thomaidis
    • 1
  • Anna Rieger
    • 1
  • Claudia Simone Seefeldt
    • 1
  • Jonas Lange
    • 1
  • Jurgen Meyer
    • 1
  • Michael A. Stroehlein
    • 1
  • Markus M. Heiss
    • 1
  1. 1.Department of Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical Center (CMMC)Witten/Herdecke UniversityCologneGermany
  2. 2.Department of General, Visceral, Vascular and Thoracic SurgeryHospital of KemptenKemptenGermany

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