Transvaginal hybrid NOTES cholecystectomy using an internal retractor
Epublication WebSurg.com, Feb 2010;10(02). URL: http://websurg.com/doi/vd01en2892
Under general anesthesia with the patient supine in lithotomy position, a pelvic exam is performed. A first 5mm umbilical trocar is placed and an exploratory laparoscopy is performed to ascertain the feasibility of a NOTES cholecystectomy. The patient is then tilted in steep Trendelenburg. The posterior vaginal vault is carefully examined before gaining access to the peritoneal cavity. A linear cold blade scalpel incision is made in the cul-de-sac, well posterior in the fold between the uterosacral ligaments, 1cm below the uterine os.