CHICAGO (EGMN) –Outcomes were successful and patient satisfaction was high in a review of data from 22 women who underwent transvaginal cholecystectomy between August 2007 and September 2008.

The removal of the gall bladder via the vagina is an example of Natural Orifice Transluminal Endoscopic Surgery (NOTES), an evolving minimally invasive technique designed to avoid an abdominal incision and reduce patient discomfort, recovery time, and length of hospital stay.

Transvaginal gall bladder removal is one of the few NOTES procedures that has been performed repeatedly in humans. Dr. Oscar M. Laudanno of the University of Buenos Aires and his colleagues presented the results of their experience in a poster at the annual Digestive Disease Week.

The average age of the 22 patients was 34 years. Ten of the women had a history of cesarean sections. The technique could not be performed in one patient because of pelvic adhesions from five previous cesarean sections, so her surgery was performed laparoscopically.

To perform the surgery, a 5-mm trocar was inserted for a diagnostic laparoscopy. The surgeons then inserted a two-way trocar under laparoscopic control through the right posterior vaginal cul-de-sac. “We entered the peritoneal cavity with a one- or two-channel video gastroscope,” Dr. Laudanno noted. The surgeons then clipped the cystic duct and artery through the umbilicus using a 5-mm clip device and removed the gall bladder through the incision of the vagina with entry into the cul-de-sac. The access was closed with absorbable stitches. The patients stayed in the hospital for 48 hours and were advised to abstain from sex for 1 month.

One patient had minor intraoperative bleeding, but no serious adverse events occurred.

The gynecologic exams and transvaginal ultrasounds were normal at 30 days after surgery. All of the women reported high levels of satisfaction and rated the procedure as either “very good” or “excellent” in follow-up interviews at 7 days, 30 days, and 60 days. Each patient said she would undergo the procedure again.

At the 60-day follow-up interview, all patients reported having had sexual intercourse, but none reported any changes in intercourse as a result of the surgery. None of the patients reported dyspareunia or problems with urinary incontinence, and none reported changes in sexual desire or in their ability to have orgasms. Two patients became pregnant during the follow-up period. One woman had an uncomplicated vaginal delivery of a healthy infant, and the other pregnancy had not reached full term when the study results were presented.

“The transvaginal NOTES access seems to be safe, with excellent outcomes, no complications, and void of negative impact in the gynecological and sexual aspects,” the researchers said.

Dr. Laudanno and his colleagues had no financial conflicts to disclose.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

芝加哥（EGMN）——对2007年8月至2008年9月接受经阴道胆囊切除术的22例女性患者的临床资料进行回顾分析表明，手术都很成功，患者都很满意。

经阴道进行胆囊切除是经自然腔道壁手术（NOTES）临床应用的一个例子，它是一种新近开展的使手术创伤最小化的技术，避免了剖腹手术，可减少患者的不适、术后恢复时间，缩短住院时间。

到目前为止，已被广泛接受用于人体的NOTES手术术式并不多，经阴道胆囊切除术即是其中的一种。布宜诺斯艾利斯大学的Oscar M. Laudanno医生及其同事在一年一度的消化疾病周的会议壁报上汇报了他们的研究结果。

22例患者的平均年龄为34周岁，其中10位患者曾行剖宫产。1例患者因过去曾进行过5次剖宫产手术造成盆腔粘连，而不能行经阴道胆囊切除术，最终采用腹腔镜方法切除了胆囊。

进行阴道胆囊切除术时，首先需要插入一个5 mm的套管针来进行诊断性内镜检查。然后，医生会在经阴道穹隆右后方探入的内镜监视下插入一个双路的套管针。“我们将单或双通道内镜探入腹膜腔” Laudanno说。接着，医生通过脐用一枚5mm的夹子夹毕胆囊管和胆囊动脉，并通过阴道穹窿处阴道壁的切口切除、取出胆囊。切口用可吸收线缝合。患者需要住院48h，并被告知禁止性生活1个月。

1位患者手术中有少量出血，但没有发生严重的不良后果。

术后30天进行的妇科检查及经阴道超声检查结果均为正常。在术后第7天、30天及60天随访时，所有患者均表示满意，对手术的评价是“非常好”或者“极好”。每位患者都表示愿意再接受一次这样的手术。

在术后第60天的随访时，所有患者均表示已经有了性生活，并且感觉性生活质量没有什么改变。没有人表示出现性交困难、尿失禁、性欲或达到性高潮能力的改变。在随访过程中有两位患者怀上了孩子。其中一位母亲经阴道分娩顺产一健康婴儿，另一位母亲的小孩在本研究发表时还未达足月。
 

研究者说“经阴道的NOTES手术通路似乎是安全的，有很好的结果，没有并发症，在妇科及性生活方面也没有不良影响”。

Laudanno医生和他的同事的本研究工作没有资金方面的利益冲突。

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