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Case Reports
. 2024 Jan-Mar;28(1):e2023.00059.
doi: 10.4293/JSLS.2023.00059.

Laparoscopic-Assisted Transvaginal Cholecystectomy - the US Military Experience With Long-Term Follow Up

Carolyn Judge  1   2 , Jesse Bandle  1   2 , Andrew Wang  1   2 , Kyle Gadbois  1   2 , Amanda Simsiman  1   2 , Robin Wood  1   2 , Gordon Wisbach  1   2
Affiliations
Case Reports

Laparoscopic-Assisted Transvaginal Cholecystectomy - the US Military Experience With Long-Term Follow Up

Carolyn Judge et al. JSLS. 2024 Jan-Mar.

Abstract

Objectives: We present our initial clinical experience applying Natural Orifice Transluminal Endoscopic Surgical (NOTES) technique to perform cholecystectomy in ten patients at a military institution.

Methods: A posterior colpotomy was created to accommodate a single site working port used to facilitate dissection and gallbladder mobilization under direct visualization via an infraumbilical port. The specimen was retrieved through the vagina and the colpotomy was closed with absorbable suture under direct visualization. Long-term follow up was performed over the phone to assess quality of life with 2 widely used health-related quality of life (HRQoL) surveys including RAND-36 Health Item Survey (Version 1.0),1 and the Female Sexual Function Index (FSFI).2.

Results: Ten women underwent a laparoscopic-assisted transvaginal cholecystectomy (TVC) with 7 available for long-term follow-up. The average age was 28.9 years (20-37) and the indications for surgery included symptomatic cholelithiasis (9) and biliary dyskinesia (1). The mean operative time was 129 mins (95-180), and median blood loss was 34 ml (5-400). There were no conversions and the average length of stay was 9.98 hours (2.4-28.8). Pain (analogue scale 1-10) on postoperative day three was minimal (mean 2.3) and was limited to the infraumbilical incision. On average patients returned to work by postoperative day six and resumed normal daily activities at seven days. Immediate postoperative complications included one incident of postoperative urinary retention requiring bladder catheterization. One intra-operative cholangiogram was successfully performed due to elevated preoperative liver enzymes without significant findings. Long-term complications included one asymptomatic incisional hernia repair at the infraumbilical port site. The RAND-36 survey demonstrated an average physical and mental health summary score of 82.2 and 63.7 with an average general health score of 63.6. The average FSFI total score was 21.8.

Conclusion: TVC is safe and effective. Implementation may improve operational readiness by returning service members to normal activities more expeditiously than conventional laparoscopy.

Keywords: Endoscopic surgery; NOTES; Natural orifice transluminal endoscopic surgery; Transvaginal cholecystectomy.

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Figures

Figure 1.
Figure 1.
Patient and surgical team positioning. Endoscopic unit is a Stryker TowerTM.
Figure 2.
Figure 2.
Olympus Triport™ (TriPort, Olympus, Center Valley, PA) single site port.
See this image and copyright information in PMC

References

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