Translate case to... Transvaginal cholecystectomy (NOTES) combined with minilaparoscopy

Objective. To report on the first transvaginal cholecystectomy performed on a human being in our country.

Patients and methods: Thirty-five-year-old female with a history of recurrent bouts of liver colic resulting from gallstones. The intervention was performed by a multidisciplinary team composed of surgeons, gastroenterologists, and gynecologists. It involved creating pneumoperitoneum by placing a Veress needle in the umbilical fundus, followed by insertion of a 5 mm trocar. A second, 3 mm trocar was placed in the right upper quadrant. Colpotomy was performed, and a 12 mm trocar placed inside the vagina allowed insertion of the videogastroscope as far as the hilum of the liver.

Results: The cholecystectomy was performed by using a combination of working tools inserted through the entry port for the minilaparoscopy and the videogastroscope. The gallbladder was removed transvaginally through the videogastroscope. There were no postoperative complications, and the patient was discharged in 24 hours.

Conclusions: Transvaginal cholecystectomy is possible and safe when performed by a multidisciplinary team working together. Natural orifice transluminal endoscopic surgery (NOTES) is an emerging modality that seeks to be less invasive, better tolerated, and more respectful of aesthetics than laparoscopic surgery. It will probably open the way for very important medical and technological innovations over the coming years.