Skip to main content
SpringerLink
Log in

Transvaginal cholecystectomy versus single-incision laparoscopic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective cohort study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Objective

This report describes the first prospective cohort study comparing transvaginal cholecystectomies (TVC) with single incision laparoscopic cholecystectomies (SILC) and four-port laparoscopic cholecystectomies (4PLC).

Methods

Between May 2009 and August 2010, 14 patients underwent a TVC. These patients were compared with patients who underwent SILC (22 patients) or 4PLC (11 patients) in a concurrent, randomized, controlled trial. Demographic data, operative time, numerical pain scales, complications, and return to work were recorded.

Results

Mean age (TVC: 33.5 ± 3.0 year; SILC: 38.4 ± 3.3 year; 4PLC: 35.5 ± 4.1 year; p = 0.58) and mean BMI (TVC: 28.8 ± 1.5 kg/m2; SILC: 31.8 ± 1 kg/m2; 4PLC: 31.4 ± 2.2 kg/m2; p = 0.35) were not statistically significant. However, mean operative time (TVC: 67 ± 3.9 min; SILC: 48.9 ± 2.6 min; 4PLC: 42.3 ± 3.9 min; p < 0.001) was significantly longer for TVC. Numerical pain scales showed significantly lower pain scores on POD 1 and 3 for TVC compared with SILC and 4PLC (TVC: 4.1 ± 0.5 and 2.9 ± 0.7; SILC: 6.1 ± 0.5 and 5.3 ± 0.5; 4PLC: 5.7 ± 0.4 and 4.7 ± 0.3; p = 0.02) with equilibration of pain scores by days 14 and 30. Return to work (TVC: 6.4 ± 1.5 days; SILC: 13.1 ± 1.3 days; 4PLC: 14.1 ± 1.4 days; p < 0.001) also was significantly faster for patients in the TVC group. One conversion in the TVC group to a 4PLC was necessary due to adhesions within the pelvis. One dislodged IUD was seen and immediately replaced in the TVC group. One hernia was observed in the SILC group.

Conclusions

Transvaginal cholecystectomy is a safe and well-tolerated procedure with statistically significantly less pain at 1 and 3 days after surgery, with a faster return to work but longer operative times compared with single incision and four-port laparoscopic cholecystectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cameron JL, Gadacz TR (1991) Laparoscopic cholecystectomy. Ann Surg 213(1):1–2

    Article  PubMed  CAS  Google Scholar 

  2. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84(5):695

    Article  PubMed  CAS  Google Scholar 

  3. Hernandez J, Ross S, Morton C, McFarlin K, Dahal S, Golkar F, Albrink M, Rosemurgy A (2010) The learning curve of laparoendoscopic single-site (LESS) cholecystectomy: definable, short, and safe. J Am Coll Surg 211(5):652–657

    Article  PubMed  Google Scholar 

  4. Hernandez JM, Morton CA, Ross S, Albrink M, Rosemurgy AS (2009) Laparoendoscopic single site cholecystectomy: the first 100 patients. Am Surg 75(8):681–685; discussion 685–686

    PubMed  Google Scholar 

  5. Erbella J, Bunch GM (2010) Single-incision laparoscopic cholecystectomy: the first 100 outpatients. Surg Endosc 24(8):1958–1961

    Article  PubMed  Google Scholar 

  6. Zorrón R, Filgueiras M, Maggioni LC, Pombo L, Lopes Carvalho G, Lacerda Oliveira A (2007) NOTES. Transvaginal cholecystectomy: report of the first case. Surg Innov 14(4):279–283

    Article  PubMed  Google Scholar 

  7. Ramos AC, Murakami A, Galvão Neto M, Galvão MS, Silva AC, Canseco EG, Moyses Y (2008) NOTES transvaginal video-assisted cholecystectomy: first series. Endoscopy 40(7):572–575

    Article  PubMed  Google Scholar 

  8. Noguera J, Dolz C, Cuadrado A, Olea J, Vilella A, Morales R (2009) Hybrid transvaginal cholecystectomy, NOTES, and minilaparoscopy: analysis of a prospective clinical series. Surg Endosc 23(4):876–881

    Article  PubMed  Google Scholar 

  9. Roberts KE, Solomon D, Mirensky T, Silasi DA, Duffy AJ, Rutherford T, Longo WE, Bell RL (2012) Pure transvaginal appendectomy versus traditional laparoscopic appendectomy for acute appendicitis: a prospective cohort study. Ann Surg 255(2):266–269

    Article  PubMed  Google Scholar 

  10. Roberts KE, Solomon D, Duffy AJ, Bell RL (2010) Single-incision laparoscopic cholecystectomy: a surgeon’s initial experience with 56 consecutive cases and a review of the literature. J Gastrointest Surg 14(3):506–510

    Article  PubMed  Google Scholar 

  11. Uchiyama K, Kawai M, Tani M, Ueno M, Hama T, Yamaue H (2006) Gender differences in postoperative pain after laparoscopic cholecystectomy. Surg Endosc 20(3):448–451

    Article  PubMed  CAS  Google Scholar 

  12. Peters JH, Ellison EC, Innes JT, Liss JL, Nichols KE, Lomano JM, Roby SR, Front ME, Carey LC (1991) Safety and efficacy of laparoscopic cholecystectomy. A prospective analysis of 100 initial patients. Ann Surg 213(1):3–12

    Article  PubMed  CAS  Google Scholar 

  13. Solomon D, Bell RL, Duffy AJ, Roberts KE (2010) Single-port cholecystectomy: small scar, short learning curve. Surg Endosc 24(12):2954–2957

    Article  PubMed  Google Scholar 

  14. Prasad A, Mukherjee KA, Kaul S, Kaur M (2011) Postoperative pain after cholecystectomy: conventional laparoscopy versus single-incision laparoscopic surgery. J Minim Access Surg 7(1):24–27

    PubMed  CAS  Google Scholar 

  15. Khambaty F, Brody F, Vaziri K, Edwards C (2011) Laparoscopic versus single-incision cholecystectomy. World J Surg 35(5):967–972

    Article  PubMed  Google Scholar 

  16. Wu SD, Han JY, Tian Y (2011) Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a retrospective comparative study. J Laparoendosc Adv Surg Tech A 21(1):25–28

    Article  PubMed  Google Scholar 

  17. Marks J, Tacchino R, Roberts K, Onders R, Denoto G, Paraskeva P, Rivas H, Soper N, Rosemurgy A, Shah S (2011) Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 201(3):369–372; discussion 372–373

    Article  PubMed  Google Scholar 

  18. Bucher P, Ostermann S, Pugin F, Morel P (2011) Female population perception of conventional laparoscopy, transumbilical LESS, and transvaginal NOTES for cholecystectomy. Surg Endosc 25(7):2308–2315

    Article  PubMed  Google Scholar 

  19. Strickland AD, Norwood MG, Behnia-Willison F, Olakkengil SA, Hewett PJ (2010) Transvaginal natural orifice translumenal endoscopic surgery (NOTES): a survey of women’s views on a new technique. Surg Endosc 24(10):2424–2431

    Article  PubMed  Google Scholar 

  20. Swanstrom LL, Volckmann E, Hungness E, Soper NJ (2009) Patient attitudes and expectations regarding natural orifice translumenal endoscopic surgery. Surg Endosc 23(7):1519–1525

    Article  PubMed  Google Scholar 

  21. Varadarajulu S, Tamhane A, Drelichman ER (2008) Patient perception of natural orifice transluminal endoscopic surgery as a technique for cholecystectomy. Gastrointest Endosc 67(6):854–860

    Article  PubMed  Google Scholar 

  22. Peterson CY, Ramamoorthy S, Andrews B, Horgan S, Talamini M, Chock A (2009) Women’s positive perception of transvaginal NOTES surgery. Surg Endosc 23(8):1770–1774

    Article  PubMed  Google Scholar 

  23. Lehmann KS, Ritz JP, Wibmer A, Gellert K, Zornig C, Burghardt J, Büsing M, Runkel N, Kohlhaw K, Albrecht R, Kirchner TG, Arlt G, Mall JW, Butters M, Bulian DR, Bretschneider J, Holmer C, Buhr HJ (2010) The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Ann Surg 252(2):263–270

    Article  PubMed  Google Scholar 

  24. Dragisic KG, Milad MP (2004) Sexual functioning and patient expectations of sexual functioning after hysterectomy. Am J Obstet Gynecol 190(5):1416–1418

    Article  PubMed  Google Scholar 

  25. Solomon D, Lentz R, Duffy AJ, Bell RL, Roberts KE (2012) Female sexual function after pure transvaginal appendectomy: a cohort study. J Gastrointest Surg 16(1):183–186; discussion 186–187

    Article  PubMed  Google Scholar 

Download references

Disclosures

Dr. Roberts is a paid consultant to Covidien and the founder of Novatract. Drs. Solomon, Shariff, Silasi, Duffy, and Bell have no conflict of interest or financial disclosures.

Author information

Authors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, New Haven, CT, 06510, USA

    Daniel Solomon, Amir H. Shariff, Andrew J. Duffy, Robert L. Bell & Kurt E. Roberts

  2. Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, 06510, USA

    Dan-Arin Silasi

Authors
  1. Daniel Solomon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amir H. Shariff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dan-Arin Silasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrew J. Duffy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert L. Bell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kurt E. Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Solomon.

Additional information

Sources of Support

Covidien provided partial funding for this trial.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Solomon, D., Shariff, A.H., Silasi, DA. et al. Transvaginal cholecystectomy versus single-incision laparoscopic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective cohort study. Surg Endosc 26, 2823–2827 (2012). https://doi.org/10.1007/s00464-012-2253-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2253-0

Keywords

Search

Navigation