Surgery without scars - Report of transluminal cholecystectomy in a human being

Hypothesis: Natural orifice transluminal endoscopic surgery (NOTES) provides the potential for performance of incisionless operations. This would break the physical barrier between bodily trauma and surgery, representing an epical revolution in surgery. Our group at IRCAD-EITS (Institut de Recherche contre les Cancers de l'Appareil Digestif [Institute of Digestive Cancer Research] -European Institute of TeleSurgery) has been actively involved in the development of NOTES since 2004 with a dedicated project created to develop feasibility and survival studies and new endoscopic technology. Design: NOTES cholecystectomy in a woman via a transvaginal approach. Setting: University hospital. Patient: The patient was a 30-year-old woman with symptomatic cholelithiasis. Intervention: The procedure was carried out by a multi-disciplinary team using a standard double-channel flexible videogastroscope and standard endoscopic instruments. The placement of a 2-mm needle port, mandatory to insufflate carbon dioxide and to monitor the pneumoperitoneum, was helpful for further retraction of the gallbladder. At no stage of the procedure was there need for laparoscopic assistance. All of the principles of cholecystectomy were strictly adhered to. Results: The postoperative course was uneventful. The patient had no postoperative pain and no scars, and was discharged on the second postoperative day. Conclusions: Transluminal surgery is feasible and safe. NOTES, a radical shift in the practice and philosophy of interventional treatment, is becoming established and is enormously advantageous to the patient. With its invisible mending and tremendous potential, NOTES might be the next surgical evolution.