Natural orifice translumenal endoscopic surgery represents an emerging technology, and includes under its umbrella a variety of approaches and combinations.
The transvaginal approach to endoscopic cholecystectomy is one such technique, which Dr Chinnusamy Palanivelu and colleagues from India present as a small series.
The team investigated a total of 8 patients who underwent transvaginal endoscopic cholecystectomy in 2007.
The research team excluded 2 patients as they were converted to laparoscopy due to technical difficulties.
The researchers found that the average age of the patients was 35 years, and mean body mass index was 27 kg/m2.
The mean operating time was 149 minutes.
Patients were discharged in an average of 4 postoperative days.
The research team noted that the major complication rate was 16%.
|The major complication rate was 16%|
|American Journal of Gastroenterology |
The patient with a major complication had a subhepatic collection that was managed with ultrasonogram-guided aspiration followed by ERCP and stenting.
Dr Palanivelu's team concluded, “Since the first description of natural orifice translumenal endoscopic surgery, there has been no standardized technique.”
“In our technique, we used a single 3-mm trocar for visualizing the entry and exit of the endoscope, maintaining and measuring pneumoperitoneum, and retracting the gall bladder fundus.”
“The instruments that were used were the conventional endoscopic ones.”
“The transvaginal approach seems to be a viable alternative to the transgastric approach for cholecystectomy, as the transgastric approach has certain inherent problems like leakage from the gastrotomy site and poor ergonomy.”
“The downside to the transvaginal approach is that it is possible only in women.”