Transabdominal wall deployment for instruments, lights, and micromotors using the concept of secured independent tools.

Use of secured independent tools (SIT) is changing the laparoscopy paradigm, which involves the use of instruments inside the abdominal cavity that are operated via a port that is larger in diameter than the instrument itself. However, in SIT instead of ports we used filaments or cables. Here we describe a modified SIT for use in the introduction of sutures or cables inside the peritoneum. Cables or sutures are passed through a tunnel made by an intravenous catheter and then exteriorized via a 12-mm port for tying, plugging (attaching), or connecting to different types of devices such as an endoscopic bulldog, alligator clamps, lights, and micromotors. These devices are introduced inside the abdomen and remotely operated with cables or filaments. The use of SIT is not limited to laparoscopy; it was successfully used in clinical experiences of single-port and single-incision laparoscopy and could facilitate natural orifice surgery. The technique offers a good force for traction, retraction, and mobilization. In addition, it has transmission capabilities for cameras and may facilitate the placement of wired microrobotics.

Transvaginal single port cholecystectomy.

BACKGROUND: Transvaginal cholecystectomy encourages researchers to develop new hybrid or pure techniques for natural orifice surgery. We present an approach that combines flexible endoscopes, rigid instruments, and percutaneous needles. METHODS: A 26-year-old female patient with cholelithiasis underwent a single-port culdolaparoscopy cholecystectomy at "Hospital Regional Poza Rica" (Poza Rica, Mexico) on July 2008. The surgery was performed with only 1 transvaginal 16 mm in diameter by 32 cm in length port. The instruments included a gastroscope, laparoscopic 5 mm in diameter by 43 cm in length instruments, percutaneous reins, and hook needle. RESULTS: The patient was discharged 24 hours after surgery, which is customary for the hospital, without pain or visible scars. CONCLUSIONS: Single transvaginal port cholecystectomy using a gastroscope and laparoscopic 5 mm instruments in a parallel path is a feasible procedure in selected patients. This technique requires no abdominal ports assistance.

Postoperative patient attitudes and perceptions of transvaginal cholecystectomy.

A survey was conducted in order to dispel misconceptions about natural orifice transvaginal cholecystectomy. Forty-two patients were surveyed after having undergone that procedure. Those patients were asked questions related to 1) patient satisfaction, 2) whether they would recommend the procedure to others, and 3) dyspaurenia. The survey was done after a sexual abstinence period that varied from 30 to 40 days. We encountered no complications, and all patients liked the procedure and would recommend it to family and friends. No patient developed dyspaurenia. The postoperative responses were unanimous and positive for all questions. The result of this postoperative transvaginal cholecystectomy survey will help patients and surgeons ease their fears and social taboos and better communicate, and this will help patients to become aware of the option of transvaginal peritoneoscopy.