Transvaginal cholecystectomy without laparoscopic support using prototype flexible endoscopic instruments in a porcine model.

Background: Transvaginal cholecystectomy with laparoscopic assistance has been performed safely in humans. The next goal was to develop a natural orifice transluminal endoscopic surgery (NOTES) technique to perform cholecystectomy without laparoscopic instruments using one flexible endoscope and flexible accessories. The aim of the study was to test the feasibility of the procedure in a survival porcine model.

Transvaginal cholecystectomy by using a prototype flexible clip applier.

Background: Currently, no endoscopic clips have been proven to be effective in ligating the cystic duct in natural orifice transluminal endoscopic surgery (NOTES) hybrid cholecystectomy.

Objective: To determine the safety and feasibility of a prototype endoscopic flexible clip applier, which is the only flexible device that deploys a zero-gap clip.

Design: Pilot study in a survival porcine model.

Transumbilical single-port laparoscopic adjustable gastric band placement with liver suture retractor.

Background: The evolution of single-incision laparoscopic surgery (SILS) has no doubt been impacted by the decrease or elimination of incisions seen with natural orifice transluminal endoscopic surgery (NOTES). SILS upholds the principal advantages of minimal access surgery including shortened hospital stays, the potential for decreased postoperative pain, and cosmetically acceptable scars by reducing large or multiple incisions to a relatively small, single one.

Methods: As opposed to NOTES, SILS does not violate a natural orifice and so the potential for contamination is identical to that of laparoscopy.