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Scarless cholecystectomy with combined transvaginal and transumbilical approach in a series of 20 patients

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Abstract

Background

Laparoscopic surgery has dramatically improved surgical care of patients reducing postoperative pain, wound infection rate, hospital stay, inability to work, risk of hernia, and cosmetic result. Natural orifice transluminal endoscopic surgery (NOTES) is even less traumatic to the abdominal wall and might further improve minimal invasive surgery of patients, but might also increase surgical risk when used by a transgastric or transcolonic approach with flexible endoscopes. Therefore we decided to use a transvaginal approach using rigid laparoscopic instruments for cholecystectomies.

Methods

Through a 5-mm incision deep in the umbilicus a pneumoperitoneum was created. The optic and a dissector were inserted through the posterior fornix of the vagina under laparoscopic control from the umbilicus and a transvaginal gallbladder removal was performed.

Results

20 patients were successfully operated in a 4.5-month period. Operating time was 62 (35–100) min. No intra- or postoperative complications occurred in any patient. Gynecological examination after 8 days showed no negative findings and the cosmetic result was ideal with no visible scars.

Conclusion

In our series we showed that cholecystectomies can be routinely performed in a NOTES technique without visible scar. The transvaginal approach is the safe in NOTES and common laparoscopic instruments can be used as long as there are no better flexible endoscopes for this purpose.

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References

  1. Kaloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117

    Article  Google Scholar 

  2. Jagannath SB, Kantesevoy SV, Vaughn CA, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Scorpio DG, Magee CA, Pipitone LJ, Kalloo AN (2005) Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in porcine model. Gastrointest Endosc 61:449–453

    Article  PubMed  Google Scholar 

  3. Park PO, Bergström M, Ikeda K, Fritscher-Ravens A, Swain P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis. Gastrointest Endosc 61:601–606

    Article  PubMed  Google Scholar 

  4. Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, Thompson CC (2006) Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model. Gastrointest Endosc 64:428–434

    Article  PubMed  Google Scholar 

  5. Kantsevoy SV, Hu B, Jagannath SB, Vaughn CA, Beitler DM, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Pipitone LJ, Talamini MA, Kalloo AN (2006) Transgastric endoscopic splenectomy. Is it possible? Surg Endosc 20:522–525

    Article  CAS  Google Scholar 

  6. 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 

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

  8. Rubin R (2007) Surgery offers less scarring. USA Today, 6 August 2007, p 7D

  9. Marescaux J, Dallemagne B, Peretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142:823–826

    Article  PubMed  Google Scholar 

  10. Zornig C, Mofid H, Emmermann A, Alm M, von Waldenfels HA, Felixmüller C (2007) Laparoscopic cholecystectomy without visible scar: combined transvaginal and transumbilical approach. Endoscopy 39:913–915

    Article  PubMed  CAS  Google Scholar 

  11. Zornig C, Emmermann A, von 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 

  12. 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 

  13. 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 

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Authors and Affiliations

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

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

  2. Praxisklinik Winterhude for Gynecology and Obstetrics, Mühlenkamp 32, 22303, Hamburg, Germany

    H.-A. von Waldenfels & C. Felixmüller

Authors
  1. C. Zornig
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  2. H. Mofid
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  3. A. Emmermann
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  4. M. Alm
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  5. H.-A. von Waldenfels
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  6. C. Felixmüller
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Corresponding author

Correspondence to C. Zornig.

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Zornig, C., Mofid, H., Emmermann, A. et al. Scarless cholecystectomy with combined transvaginal and transumbilical approach in a series of 20 patients. Surg Endosc 22, 1427–1429 (2008). https://doi.org/10.1007/s00464-008-9891-2

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  • DOI: https://doi.org/10.1007/s00464-008-9891-2

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