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. 2017 Jul-Sep;13(3):176-181.
doi: 10.4103/0972-9941.207838.

Natural orifice transluminal endoscopic surgery (hybrid) cholecystectomy: The Dhillon technique

Kanwarjit Singh Dhillon  1 , Divya Awasthi  2 , Arshbir Singh Dhillon  3
Affiliations

Natural orifice transluminal endoscopic surgery (hybrid) cholecystectomy: The Dhillon technique

Kanwarjit Singh Dhillon et al. J Minim Access Surg. 2017 Jul-Sep.

Abstract

Introduction: This study presents a novel technique to perform cholecystectomy and assess its outcome and feasibility.

Patients and methods: This study presents the novel Dhillon technique and experience of hybrid natural orifice transluminal endoscopic surgery (NOTES) technique, that is, laparoscopic-assisted transvaginal cholecystectomy. We have evaluated the outcomes in terms of cosmesis, post-operative recovery and analgesic requirement. The study included 257 patients who underwent hybrid NOTES cholecystectomy at single tertiary hospital. The biographical data, surgical time, pain score on day 1 and 2, need of analgesia, intra- and post-operative complication and aesthetic assessment on day 7 were recorded.

Results: Out of a total of 1100 cases of laparoscopic cholecystectomy 257 had hybrid NOTES cholecystectomy. Only two of these cases were converted to standard laparoscopic cholecystectomy. The mean operative time was 31.5 ± 5.1 (25-40) min. None of the patients had any complication or biliary leakage. The mean pain score on day 1 and 2 was 3.6 ± 0.4 (3-4) and 1.0 ± 0.06 (1-2), respectively. The mean paracetamol (analgesic) dose requirement was 6.1 ± 0.6 (4-6.9) g. The aesthetic score was excellent in all the cases.

Conclusions: Using the present technique of hybrid NOTES is beneficial in terms of cosmetic results, lesser need of analgesic and shorter hospital stay.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Surgical technique (abdominal part): (a and b) Skin incisions at umbilicus. (c) Abdominal ports of 5 mm through umbilicus. (d) Endoscopic view of umbilical ports. (e) Examination of pelvic cavity through umbilical port
Figure 2
Figure 2
Surgical technique (vaginal part): (a) External view of vaginal 10 mm port. (b) Endoscopic view of vaginal 10 mm port. (c) Endoscopic view of gall bladder dissection through vaginal telescope. (d) Removal of gall bladder intact through vagina under vision from umbilical telescope. (e) Closure of port in the posterior vaginal fornix
Figure 3
Figure 3
Post-operative skin incision site
See this image and copyright information in PMC

References

    1. Meljnikov I, Radojcic B, Grebeldinger S, Radojcic N. History of surgical treatment of appendicitis. Med Pregl. 2009;62:489–92. - PubMed
    1. Litwin DE, Cahan MA. Laparoscopic cholecystectomy. Surg Clin North Am. 2008;88:1295–313, ix. - PubMed
    1. Shea JA, Berlin JA, Bachwich DR, Staroscik RN, Malet PF, McGuckin M, et al. Indications for and outcomes of cholecystectomy: A comparison of the pre and postlaparoscopic eras. Ann Surg. 1998;227:343–50. - PMC - PubMed
    1. Arulampalam T, Paterson-Brown S, Morris A. Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI); Association of Coloproctology of Great Britain and Ireland (ACPGBI); Association of Upper Gastro-intestinal Surgeons of Great Britain and Ireland (AUGIS); British Association of Urological Surgeons (BAUS); British Society of Gynaecological Endoscopy (BSGE); British Obesity and Metabolic Surgical Society (BOMSS); British Society of Gastroenterology (BSG). Natural orifice transluminal endoscopic surgery. Ann R Coll Surg Engl. 2009;91:456–9. - PubMed
    1. Delvaux G, Devroey P, De Waele B, Willems G. Transvaginal removal of gallbladders with large stones after laparoscopic cholecystectomy. Surg Laparosc Endosc. 1993;3:307–9. - PubMed