gms | German Medical Science

129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

New Transvaginal Port System for Rigid and Flexible NOTES Cholecystectomy – Human Experience

Meeting Abstract

  • Ricardo Zorron - Klinikum Bremerhaven Reinkenheide, Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Bremerhaven
  • Elena Dubcenco - Klinikum Bremerhaven Reinkenheide, Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Bremerhaven
  • Henrique Phillips - Klinikum Bremerhaven Reinkenheide, Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Bremerhaven
  • Tido Junghans - Klinikum Bremerhaven Reinkenheide, Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Bremerhaven

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch270

DOI: 10.3205/12dgch270, URN: urn:nbn:de:0183-12dgch2702

Published: April 23, 2012

© 2012 Zorron et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objectives: Transvaginal NOTES is a new diagnostic and potentially therapeutic method of surgical endoscopy, and worldwide clinical experience is still limited. A new Transvaginal Access Platform was specially designed for natural orifice surgery and tested in our Institution. A preliminary clinical experience with a new vaginal port and instruments for NOTES transvaginal cholecystectomy is described, in a series of 8 patients.

Methods: IRB approval was obtained at the institution for transvaginal NOTES clinical trials using the port access. This technique of transvaginal NOTES cholecystectomy was clinically applied in 8 patients with symptomatic cholelithiasis. Transvaginal NOTES access was obtained with an open posterior colpotomy. Either a flexible or rigid technique using single channel gastroscope or a long rigid laparoscope was introduced in the abdominal cavity transvaginally through the vaginal access platform (KarlStorz, Tuttlingen, Germany). The technique allowed the use of rigid and semiflexible instruments transvaginally for retraction and clipping. If laparoscopic assistance was used, the choice was umbilical puncture for use of 3 mm retraction. The posterior colpotomy was closed with absorbable sutures.

Results: Operative time ranged from 50 to 190 minutes. Operative bleeding was a mean of less than 50 ml. Intraabdominal pressure ranged from 6 to 14 mmHg. There was a need for a 3 mm laparoscopic trocar in 3 patients for retraction, or ligature. The patients recovered well postoperatively, oral intake has began on the next day. There were no postoperative complications, and vaginal discomfort was minimal.

Conclusions: Tranvaginal NOTES is a feasible and safe alternative method for cholecystectomy using the new access device in this preliminary clinical experience. Although available technology is still limited for natural orifice surgery, laparoscopic assistance can be indicated for safer and faster procedures in difficult cases.