Woman’s gallbladder removed with instruments passed through her vagina – what is the feasibility and technical aspect of a transvaginal flexible endoscopic cholecystectomy? What is next wave of hybrid laparoscopicendolumenal procedures? Transgastric human appendectomy? Splenectomy? Abdominal aorta repair?
Marc Bessler, MD of the Minimal Access Surgery Center at Columbia University says that Endoscopic Cholecystectomy is feasible in humans, both man and woman, and he has done a transvaginal case successfully.
In the hybrid laparoscopic-endolumenal transvaginal procedure one trocar is needed for the laparoscopic grasper that retracts the fundus of the gallbladder. The rest is done with a 12 mm dual channel therapeutic gastroscope. Once the vaginal posterior wall is penetrated and the abdomen is entered, the gallbladder is manipulated with one endoscopic and one laparoscopic grasper. The cystic duct may be isolated with an endoscpic hook cautery device and a blunt grasper. Occluding the cystic duct is currently done with an endoscopic loop ligature; the need is apparent for an endoscopic clip that fully occludes tissue.
With the help of linear and rotational deflection of the tip of the endoscope, the tissue around the cystic artery is dissected. The gallbladder is freed out of the liver bed it is brought out through the opening in the vaginal posterior wall. SAGES 2007 and the exciting case reports show that NOTES is here to stay.
Further – the future ain’t what it used be.
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