27 - Freie Mitteilung
15. Mai 2019, 15:30 - 17:00, Bellavista 2, 6. OG
Natural Orifice Transluminal Endoscopic Surgery (NOTES): Nine years` experience with 571 hybrid transvaginal cholecystectomies
F. Rössler, U. Bieri, A. Keerl, A. Nocito, Presenter: F. Rössler (Baden)
To assess outcome and safety of 571 hybrid NOTES cholecystectomies, representing the largest single-center cohort.
We retrospectively analyzed all consecutive NOTES cholecystectomies performed in our center between June 2009 and January 2018. All procedures were performed using a hybrid transvaginal technique, including an additional umbilical small-size trocar. Endpoints, calculated at discharge, 30 and up to 90 days postoperatively, included intra- and postoperative morbidity assessed by the validated Clavien-Dindo Classification and the Comprehensive Complication Index (CCI). Special focus was held on pre- and postoperative gynecological conditions and whether or not preoperative gynecological examination is necessary in all patients.
We performed 571 hybrid NOTES cholecystectomies within nine years. The vast majority were elective, 9.6% emergency cholecystectomies. Mean operation time was 64 (±25) minutes and mean hospital stay 2.56 (±3.3) days, (range 1 to 54 days). 6.7% of patients developed at least one complication until discharge, most of them minor (≤Grade II), mainly due to urinary infections or retention. 30- and 90-day complication rates were 10.7% and 11%, respectively. Mean CCI at discharge, postoperative day 30 and 90 was 1.45 (±6.4), 2.3 (±7.7) and 2.4 (±7.8) respectively, ranging from 0 to 60.1. 1.6% of patients developed major complications (≥Grade IIIa) and four patients required emergency reoperation. No mortality was observed. In 9.8% an additional abdominal trocar was placed, but only one patient needed conversion to laparotomy. All patients underwent routine gynecological examination, whereof only five were rejected for transvaginal access preoperatively. In no case transvaginal access was discontinued intraoperatively due to gynecological disease.
Hybrid NOTES transvaginal cholecystectomy represents a safe and feasible alternative to standard laparoscopic cholecystectomy. Preoperative gynecological examination is no longer routinely necessary, as intraoperative assessment is adequate.