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NOTES („natural orifice transluminal endoscopic surgery“) has the potential to optimize minimally invasive surgery. In gynecology there is extensive experience with the transvaginal approach to the abdominal cavity. It is easy to perform, closure is safe and there is little risk of infection. Hence, this is the approach most suitable for NOTES. By means of rigid laparoscopic instruments cholecystectomy can be routinely performed. Such operations could be performed in 149 patients in our hospital and the NOTES register of the DGAV has data on more than 900 transvaginal operations. [ABSTRACT FROM AUTHOR]

Laparoscopic surgery has dramatically improved surgical care of patients reducing postoperative pain, wound infection rate, hospital stay, inability to work, risk of hernia, and cosmetic result. Natural orifice transluminal endoscopic surgery (NOTES) is even less traumatic to the abdominal wall and might further improve minimal invasive surgery of patients, but might also increase surgical risk when used by a transgastric or transcolonic approach with flexible endoscopes. Therefore we decided to use a transvaginal approach using rigid laparoscopic instruments for cholecystectomies. Through a 5-mm incision deep in the umbilicus a pneumoperitoneum was created. The optic and a dissector were inserted through the posterior fornix of the vagina under laparoscopic control from the umbilicus and a transvaginal gallbladder removal was performed. 20 patients were successfully operated in a 4.5-month period. Operating time was 62 (35–100) min. No intra- or postoperative complications occurred in any patient. Gynecological examination after 8 days showed no negative findings and the cosmetic result was ideal with no visible scars. In our series we showed that cholecystectomies can be routinely performed in a NOTES technique without visible scar. The transvaginal approach is the safe in NOTES and common laparoscopic instruments can be used as long as there are no better flexible endoscopes for this purpose. [ABSTRACT FROM AUTHOR]