Transvaginal cholecystectomy: a novel surgical technique

Over the past 25 years, there has been a swift evolution of techniques for the performance of a cholecystectomy. In an effort to reduce pain, scar size and recovery time, laparoscopy has largely replaced the traditional open technique. Endeavours to eliminate surface scar formation and reduce postoperative pain have led to the development of natural orifice transluminal endoscopic surgery (NOTES). In NOTES a flexible endoscope is passed through an existing bodily orifice to reach the abdominal cavity. Transvaginal cholecystectomy (TVC) is the most commonly performed NOTES procedure. It involves accessing the abdominal cavity through a posterior colpotomy and using the vaginal incision as an operative port. TVC is a feasible operation when performed by senior surgeons highly trained in endoscopy. Issues such as surgical platform, spatial orientation, and technical challenge must be addressed before TVC is routinely practised. Patient preference, postoperative sexual function, and dyspareunia need to be thoroughly investigated. This review aimed to explore TVC in detail, as well as barriers to its widespread clinical use, and future implications.