inTRoduCTion of noTEs in THE nETHERlAnds, CHolECysTECTomy wiTHouT visiblE sCARs: THE TRAnsvAGinAl mETHod

AbSTRACT The laparoscopic cholecystectomy is the standard procedure for symptomatic gallstones disease. NOTES (Natural Orifice Transluminal Endoscopic Surgery) is the logical next step in the development towards minimal invasive surgery. During a NOTES procedure, a natural orifice, like the vagina, is used to gain access to the peritoneal cavity instead of incisions through the abdomen. In this article we report the introduction of the NOTES technique in the Netherlands. Recently 15 women were treated at our institution with a transvaginal cholecystectomy. The performed procedure was a hybrid NOTES cholecystectomy. Only one trocar was inserted through the umbilicus, the other instruments were inserted through the vagina. Potential advantages of this technique includes a better cosmetic result and less postoperative pain. In the near future, this technique should be investigated in a randomized controlled trial.