Transvaginal Cholecystectomy With Endoscopic Submucosal Dissection Instruments and Single-channel Endoscope

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Abstract
Background Natural orifice transluminal endoscopic surgery has received much attention in recent years. Instead of using prototype devices, we explored the feasibility and practicability of using readily available off-the-shelf devices to perform Natural Orifice Transluminal Endoscopic Surgery in an animal model. Methods Twenty pigs underwent transvaginal cholecystectomy, 16 of which were used for surviving study after the procedure. A single-channel endoscope and standard instruments for endoscopic submucosal dissection (hook knife and Insulated Tip knife) were used for cholecystectomy. A single 5-mm laparoscopic port was inserted for gallbladder retraction. Results Completion of the procedure was achieved in all 20 pigs. In 16 pigs, which were used for surviving study after surgery, 15 survived. Death of 1 pig was due to leakage of urine from the colpotomy and urogenital sinus. Technical success was achieved in the access, dissection, and retrieval of specimen in all the animals. Conclusions A hybrid approach with single-channel endoscope together with endoscopic submucosal dissection instruments for transvaginal cholecystectomy was shown to be safe and feasible in this pig model and this serves as a good training model before application of this technique in human. A distinct pattern of complications was identified and needed to be addressed.