CHICAGO (EGMN) –Outcomes were successful and patient satisfaction was high in a review of data from 22 women who underwent transvaginal cholecystectomy between August 2007 and September 2008.
The removal of the gall bladder via the vagina is an example of Natural Orifice Transluminal Endoscopic Surgery (NOTES), an evolving minimally invasive technique designed to avoid an abdominal incision and reduce patient discomfort, recovery time, and length of hospital stay.
Transvaginal gall bladder removal is one of the few NOTES procedures that has been performed repeatedly in humans. Dr. Oscar M. Laudanno of the University of Buenos Aires and his colleagues presented the results of their experience in a poster at the annual Digestive Disease Week.
The average age of the 22 patients was 34 years. Ten of the women had a history of cesarean sections. The technique could not be performed in one patient because of pelvic adhesions from five previous cesarean sections, so her surgery was performed laparoscopically.
To perform the surgery, a 5-mm trocar was inserted for a diagnostic laparoscopy. The surgeons then inserted a two-way trocar under laparoscopic control through the right posterior vaginal cul-de-sac. “We entered the peritoneal cavity with a one- or two-channel video gastroscope,” Dr. Laudanno noted. The surgeons then clipped the cystic duct and artery through the umbilicus using a 5-mm clip device and removed the gall bladder through the incision of the vagina with entry into the cul-de-sac. The access was closed with absorbable stitches. The patients stayed in the hospital for 48 hours and were advised to abstain from sex for 1 month.
One patient had minor intraoperative bleeding, but no serious adverse events occurred.
The gynecologic exams and transvaginal ultrasounds were normal at 30 days after surgery. All of the women reported high levels of satisfaction and rated the procedure as either “very good” or “excellent” in follow-up interviews at 7 days, 30 days, and 60 days. Each patient said she would undergo the procedure again.
At the 60-day follow-up interview, all patients reported having had sexual intercourse, but none reported any changes in intercourse as a result of the surgery. None of the patients reported dyspareunia or problems with urinary incontinence, and none reported changes in sexual desire or in their ability to have orgasms. Two patients became pregnant during the follow-up period. One woman had an uncomplicated vaginal delivery of a healthy infant, and the other pregnancy had not reached full term when the study results were presented.
“The transvaginal NOTES access seems to be safe, with excellent outcomes, no complications, and void of negative impact in the gynecological and sexual aspects,” the researchers said.
Dr. Laudanno and his colleagues had no financial conflicts to disclose.
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