Natural Orifice Transluminal Endoscopic Surgery: Long-Term Experience with Hybrid Transvaginal Cholecystectomies

Abstract

Objective. To assess outcome and safety of 571 hybrid natural orifice transluminal endoscopic surgery (NOTES) cholecystectomies. Methods. We retrospectively analyzed all consecutive NOTES cholecystectomies performed at our center between June 2009 and January 2018. All procedures were performed using a hybrid transvaginal technique, including an umbilical small-size trocar. End points, calculated at discharge, 30 and up to 90 days postoperatively, included intra- and postoperative morbidity assessed by the validated Clavien–Dindo classification and the Comprehensive Complication Index (CCI). Special focus was held on outcome and necessity of pre- and postoperative gynecological examinations. Results. We performed 571 hybrid NOTES cholecystectomies within 9 years. The vast majority were elective, 9.6% were emergency cholecystectomies. 6.7% of patients developed at least one complication until discharge, most of them minor (≤grade II). 30- and 90-day complication rates were 10.7% and 11%, respectively. Mean CCI at discharge and postoperative days 30 and 90 was 1.45 (±6.4), 2.3 (±7.7), and 2.4 (±7.8), respectively. Major complications (≥grade IIIa) occurred in 1.6% of patients, and 4 patients required emergency reoperation. No mortality was observed. In 9.8%, an additional abdominal trocar was placed. All patients underwent routine gynecological examination, whereof only 5 were rejected for transvaginal access preoperatively. In no case transvaginal access was discontinued intraoperatively due to gynecological disease. Conclusion. Hybrid NOTES transvaginal cholecystectomy represents a safe and feasible alternative to standard laparoscopic cholecystectomy. Preoperative gynecological examination is no longer routinely necessary, as intraoperative assessment is adequate.

Diagnosing and Treating Infertility via Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Laparoendoscopic Single-Site Surgery: A Retrospective Study

“…Compared with LESS, vNOTES offers a larger space and a decreased incidence of instrument clashing during handling because of the large colpotomy incision [ 38 , 39 ]. A reduction in port-associated complications such as hernias, vascular and soft-tissue traumatic injuries during trocar insertion, and nerve injuries was also demonstrated.…”

Transgastric versus transrectal: Which access route is the best for NOTES gallbladder‐preserving gallstone therapy?

“…Adequate access to the peritoneal cavity for a NOTES procedure remains a goal of surgeons and gastroenterologists. The transgastric and transvaginal route have been the most widely reported routes to obtain abdominal access for NOTES 9,23,24 . It is commonly believed that an upper GI entry facilitates the access to the lower abdominal organ, and lower GI access is better for the upper abdominal organ.…”

“…[1][2][3] Since Rao et al's description of the first human NOTES procedure in 2004, 4 over 800 full reports describing various NOTES applications in both animal experiments and clinical trials have been published. [5][6][7][8][9] The abstract of this study has been presented at Digestive Disease Weak (DDW) 2020 and consequently published on Gastrointest Endosc. 2020;91(6 Suppl):AB58-AB59.…”

“…Natural orifice transluminal endoscopic surgery (NOTES) is a novel modality that is being developed to offer a scar‐free surgery 1–3 . Since Rao et al's description of the first human NOTES procedure in 2004, 4 over 800 full reports describing various NOTES applications in both animal experiments and clinical trials have been published 5–9 . This reflects the great interest by gastroenterologists and surgeons as well as the potential of NOTES to revolutionize the use of an ultra‐minimally invasive technique for the diagnosis and/or treatment of mediastinal, thoracic, peritoneal, retroperitoneal, and pelvic pathologies 10–12 …”

Transvaginal Hybrid-NOTES procedures—do they have a negative impact on pregnancy and delivery?

“…All patients in our study routinely underwent a pre-and postoperative gynecological examination to capture preoperative risks and monitor postoperative complications created by the transvaginal access. However, the analysis of Rossler et al concludes that preoperative gynecological examination is no longer routinely necessary [16]. In gynecology, using the posterior vault of the vagina is an established method when fertility diagnostics require an intraabdominal view, and it is even used for reconstructive surgery of the internal female genitals [17].…”