Transvaginal laparoscopic cholecystectomy combined with myomectomy(NOTES)

Abstract

Summary: Recently, we successfully performed transvaginal laparoscopic cholecystectomy combined with hysteromyomectomy (NOTES) for a 42-year-old female patient. It is reported that this operation is the first hard-mirror combined NOTES operation reported in China. The patient, Ms. Chen, was diagnosed with multiple gallstones, chronic cholecystitis and multiple uterine leiomyomas. Patients hope that one-off surgery can solve two problems and reduce the pain. The patient was operated on August 8, 2018. Firstly, the gynecologist enters the abdominal cavity via vagina and establishes pneumoperitoneum. Then the hepatobiliary and pancreatic surgeon completes laparoscopic cholecystectomy. Finally, the gynecologist performs hysteromyomectomy. The operation was successful with a total length of 2.5 hours and bleeding of about 50 ml. Ms. Chen recovered well and was discharged on the second day. Return to the hospital a week ago, all indicators were normal. Transvaginal suture into abdominal cavity and vaginal incision is a very mature routine technique in reproductive gynecology. The suture of vaginal puncture hole is relatively simple. Preoperative vaginal preparation can effectively control abdominal infection. All these provide theoretical basis and technical support for our transvaginal NOTES operation. As a new minimally invasive technique, NOTES has the advantage of no scar in abdomen compared with laparotomy and traditional laparoscopic surgery, thus avoiding incision infection, surgical scar and postoperative hernia. At the same time, it can reduce postoperative pain, shorten hospitalization time, and reduce postoperative abdominal adhesion. We use hard mirror to perform NOTES operation without any incision in the abdomen. In the future, NOTES operation and 3D laparoscopic technique will be the development trend of minimally invasive surgery.