Hybrid NOTES cholecystectomy using a transsigmoid approach – towards a standardized and safe procedure

Background: Though already performed in humans, transluminal cholecystectomy is technically demanding and poorly standardized so far. Therefore we aimed to optimize the approach to the gall bladder and its exposition during resection. Methods and Procedures: In a pilot series of 6 pigs, optimization and standardization of NOTES-cholecystectomy using a transsigmoid approach was realized. Subsequently 12 cholecystectomies were performed for evaluation purposes. After entering the abdominal cavity by the help of a specially designed trocar (ISSA), which served as a stable gate during the complete procedure, the inf…