American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Natural orifice procedures find success in Germany and Italy

OCTOBER 25, 2017
Clinical Congress Daily Highlights, Wednesday Early Edition

Using a natural orifice such as the mouth or vagina for surgical access can provide numerous advantages over an abdominal incision. Patients recover more quickly, experience less pain, and have no visible scars on their abdomens, while the risk of postoperative complications such as wound infections and hernias is significantly reduced.

Natural Orifice Translumenal Endoscopic Surgery (NOTES) takes advantages of these benefits by passing surgical instruments and a tiny camera through a natural orifice to perform surgery. NOTES is becoming increasingly common in Germany to conduct cholecystectomies, according to a paper authored by Kai S. Lehmann, MD, Charite, Campus Benjamin Franklin, German Society for General and Visceral Surgery, Berlin, Germany, and colleagues.

The researchers, who tapped the German NOTES (GNR) registry, the largest NOTES outcome database, found that transvaginal hybrid NOTES cholecystectomy has a low complication rate and has become a frequent operation in selected centers. The most frequent specific postoperative complications, most of which were minor, included intraabdominal bleeding, extra-abdominal bleeding, urinary or vaginal infections, and intraabdominal infections. The researchers also discovered that the short-term outcome is not affected by institutional case volume.

A study of 39 patients who underwent transoral endoscopic thyroidectomy vestibular approach (TOETVA) led by Matteo Lavazza, MD, of University of Insubria, Varese, Italy, found that the procedure may provide a method for excellent cosmetic results. In the study, all procedures were performed without conversions, with only one case of transient postoperative hypocalcemia. The researchers concluded that the results are encouraging and said they are optimistic about the future expansion of its applicability.

Additional Information:
The Scientific Forums presentations, (SF33) Outcomes of Transvaginal NOTES Cholecystectomy; (SF59) Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) with Standardized Neural Monitoring, occurred at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available at

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