Laparoscopic surgery has decreased trauma and improved results and natural orifice transluminal endoscopic surgery (NOTES) should be a further step in this direction. However the use of flexible gastroscopes in the abdomen is difficult and the generally chosen transgastric approach is not without risk. Therefore we have carried out a cholecystectomy with a combined transvaginal and transumbilical approach, using laparoscopic instruments. The optic and a dissector were inserted in the posterior fornix of the vagina, and a 5-mm trocar was inserted deep in the umbilicus. After dissection the gallbladder was removed through the vagina. The operation was done without problems within 85 minutes and left no visible scar. The postoperative course was uneventful. In NOTES the transvaginal approach has important advantages over the transgastric method (e. g. regarding sterilization and closure); standard laparoscopic instruments can be used whilst there are no flexible endoscopes that are easier to handle.
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Fong D G, Pai R D, Thompson C C.
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4 Grady D. Testing scarless surgery, doctors remove a gallbladder through the vagina. New York Times 2007 Apr 20
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5 Le Hir P. Des Français réalisent la première ablation de la vésicule sans cicatrice. Le Monde 2007 Apr 20
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6 Le Hir P. Bientôt, la chirurgie invisible. Le Monde 2007 Jun 10
C. Zornig, MD
Department of Surgery
Israelitisches Krankenhaus
Orchideenstieg 14
22297 Hamburg
Germany
Fax: +49-40-511255102
Email: zornig@ik-h.de
