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Hybrid NOTES transvaginal cholecystectomy using 2 instruments (2.2mm and 3mm)

Epublication WebSurg.com, Mar 2016;16(03). URL: http://websurg.com/doi/vd01en4694

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  • 2016-03-10
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A 79-year-old patient presented with symptomatic cholecystolithiasis without signs of cholecystitis. Biochemical parameters were normal. Sonography showed large gallstones, which is a good indication for a transvaginal approach. As we know, NOTES (natural orifice transluminal endoscopic surgery) is under constant evolution. Last year, hybrid procedures gained more importance. In our surgical department, we perform these procedures as a valid alternative for conventional laparoscopy. We observed that out patients have less pain, faster recovery, and at last almost no scar and are not at risk for incisional hernias. With this video, we describe a comfortable 2 instrument technique using a hybrid transvaginal approach. A pneumoperitoneum of 12mmHg is created using a Veress needle at the umbilicus. A 3mm port is placed. A percutaneous clamp is placed with a diameter of 2.2mm. The patient is placed in a Trendelenburg position, and the transvaginal trocar, 12mm in diameter and 15cm in length, is pushed into the posterior fornix. A conventional cholecystectomy is performed with no loss of triangulation. Transvaginal clipping (by means of a large 45cm clip applier) and extraction are performed. Transabdominal scars are closed with a simple bandage and no suturing. The colpotomy is closed using separate Vicryl 2/0 sutures. The procedure took 30 minutes. In our group, we have a mean operating time of 30 minutes for hybrid transvaginal cholecystectomies.