Skip to main content
SpringerLink
Log in

NOTES – Cholezystektomie ohne sichtbare Narben

Kombinierter transvaginaler und transumbilikaler Zugang

Combined transvaginal and transumbilical approach for cholecystectomy with no visible scarring

 

  • Klinische Studien
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Die Nutzung natürlicher Körperöffnungen als Zugangsweg für Operationen im freien Bauchraum (NOTES) könnte sich als konsequente Fortentwicklung der minimal-invasiven Chirurgie erweisen. Im Israelitischen Krankenhaus Hamburg wurden von Beginn der 1990er Jahre an Erfahrungen mit der hinteren Kolpotomie als Bergeweg in der laparoskopischen Chirurgie gesammelt. Aus diesem Grund wurde bei der Anwendung von NOTES der transvaginale Weg mit einem im Nabel gelegenen Zugang kombiniert. So wurde eine Cholezystektomie ohne sichtbare Narben möglich. Die routinemäßige Durchführung dieser Operation war auch dadurch gegeben, dass die gewohnten starren Instrumente und Optik zum Einsatz kamen. Von Juni 2007 bis April 2008 wurden 57 Patientinnen in dieser Technik operiert. Alle Operationen waren erfolgreich, die durchschnittliche Operationszeit lag bei 54 min. Es gab eine Komplikation in Form eines Douglas-Abszesses nach 3 Wochen, der laparoskopisch drainiert wurde. Alle übrigen Verläufe waren unauffällig. In einer Befragung nach mindestens 3 Monaten gab keine Patientin Beschwerden im Bereich der Scheide oder beim Geschlechtsverkehr an.

Abstract

The use of natural orifices for operations in the abdominal cavity (natural orifice transluminal endoscopic surgery, or NOTES) could be a conclusive development in the field of minimally invasive surgery. Early in the 1990s we had experiences with posterior colpotomy for removal of specimens in laparoscopic surgery. This is why we use the transvaginal approach in NOTES and combine it with a trocar hidden in the umbilicus. With this technique we could perform cholecystectomy without a visible scar. The operation could become routine also because of the use of our well-known rigid optics and instruments. From June 2007 until April 2008 we operated on 57 patients using this method. All operations finished successfully, and the mean operation time was 54 min. There was one complication. An abscess in the Douglas room had to be evacuated laparoscopically. All other postoperative courses were uneventful. After a minimum follow-up of 3 months, none of the patients had symptoms in the vagina or during sexual intercourse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Emmermann A, Zornig C, Peiper M et al (1995) Laparoscopic splenectomy. Technique and results in a series of 27 cases. Surg Endosc 9:924–927

    PubMed  CAS  Google Scholar 

  2. Fong DG, Rai RD, Thompson CC (2007) Transcolonic endoscopic abdominal exploration: a NOTES survival study in a porcine model. Gastrointest Endosc 65:312–318

    Article  PubMed  Google Scholar 

  3. Fong DG, Ryou M, Pai RD et al (2007) Transcolonic ventral hernia mesh fixation in a porcine model. Endoscopy 39:865–869

    Article  PubMed  CAS  Google Scholar 

  4. Fritscher-Ravens A, Mosse CA, Ikeda K, Swain P (2006) Endoscopic transgastric lymphadenectomy by using EUS for selection and guidance. Gastrointest Endosc 63:302–306

    Article  PubMed  Google Scholar 

  5. Grady D (2007) Testing scarless surgery, doctors remove a gallbladder through the vagina. New York Times, Apr 20

  6. Hagen ME, Wagner OJ, Christen D, Morel P (2008) Cosmetic issues of abdominal surgery: results of an enquiry into possible grounds for a natural orifice transluminal endoscopic surgery (NOTES) approach. Endoscopy 40:581–583

    Article  PubMed  CAS  Google Scholar 

  7. Jagannath SB, Kantesevoy SV, Vaughn CA et al (2005) Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in porcine model. Gastrointest Endosc 61:449–453

    Article  PubMed  Google Scholar 

  8. Johnson N, Barlow D, Lethaby A (2006) Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2:CD003677

    PubMed  Google Scholar 

  9. Kaloo AN, Singh VK, Jagannath SB et al (2004) Flexible transgastric peritoneoscopy: A novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117

    Article  Google Scholar 

  10. Kantsevoy SV, Hu B, Jagannath SB et al (2006) Transgastric endoscopic splenectomy. Is it possible? Surg Endosc 20:522–525

    Article  PubMed  CAS  Google Scholar 

  11. Kantsevoy SV, Jagannath SB, Niiyama H et al (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62:287–292

    Article  PubMed  Google Scholar 

  12. Lima E, Henriques-Coelho T, Rolanda C et al (2007) Transvesical thoracoscopy: a natural orifice transluminal endoscopic approach for thoracic surgery. Surg Endosc 21:854–858

    Article  PubMed  Google Scholar 

  13. Marescaux J, Dallemagne B, Peretta S et al (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142:823–826

    Article  PubMed  Google Scholar 

  14. Matthes K, Yusuf TE, Willingham FF et al (2007) Feasibility of endoscopic transgastric distal pancreatectomy in the porcine animal model. Gastrointest Endosc 66: 762–766

    Article  PubMed  Google Scholar 

  15. Miesfeld RR, Giarratano RC, Moyers TG (1980) Vaginal tubal ligation – is infection a significant risk? Am J Obstet Gynecol 137:183–188

    PubMed  CAS  Google Scholar 

  16. Moore ML, Cohen M, Liu GY (2003) Experience with 109 cases of transvaginal hydrolaparoscopy. J Am Assoc Gynecol Laparosc 10:282–285

    Article  PubMed  Google Scholar 

  17. Pai RD, Fong DG, Bundga ME et al (2006) Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model. Gastrointest Endosc 64:428–434

    Article  PubMed  Google Scholar 

  18. Park PO, Bergström M, Ikeda K et al (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis. Gastrointest Endosc 61: 601–606

    Article  PubMed  Google Scholar 

  19. Rubin R (2007) Surgery offers less scarring. USA Today, Aug 6

  20. Seifert H, Wehrmann T, Schmitt T et al (2000) Retroperitoneal endoscopic debridement for infected peripancreatic necrosis. Lancet 356:653–655

    Article  PubMed  CAS  Google Scholar 

  21. Wagh MS, Merrifield BF, Thompson CC (2006) Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc 63:473–478

    Article  PubMed  Google Scholar 

  22. Zornig C, Emmermann A, v Waldenfels HA, Felixmüller C (1994) Die Kolpotomie zur Präparatebergung in der laparokopischen Chirurgie (Colpotomy for removal of specimen in laparoscopic surgery). Chirurg 65:883–885

    PubMed  CAS  Google Scholar 

  23. Zornig C, Mofid H, Emmermann A et al (2007) Laparoscopic cholecystectomy without visible scar: combined transvaginal and transumbilical approach. Endoscopy 39:913–915

    Article  PubMed  CAS  Google Scholar 

  24. Zornig C, Mofid H, Emmermann A et al (2008) Scarless cholecystectomy with combined transvaginal and transumbilical approach in a series of 20 patients. Surg Endosc (im Druck)

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Department of Surgery, Israelitisches Krankenhaus, Orchideenstieg 14, 22297, Hamburg, Deutschland

    C. Zornig, H. Mofid, A. Emmermann & M. Alm

  2. Praxisklinik Winterhude für Gynäkologie und Geburtshilfe, Hamburg, Deutschland

    H.-A. v. Waldenfels & C. Felixmüller

Authors
  1. C. Zornig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Mofid
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Emmermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Alm
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H.-A. v. Waldenfels
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Felixmüller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Zornig.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zornig, C., Mofid, H., Emmermann, A. et al. NOTES – Cholezystektomie ohne sichtbare Narben. Chirurg 80, 364–369 (2009). https://doi.org/10.1007/s00104-008-1648-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-008-1648-x

Schlüsselwörter

Keywords

Search

Navigation