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Invited Critique |

Transvaginal Cholecystectomy: Does a Go From Below Halt the Thunder Down Under?  Comment on “Transvaginal Cholecystectomy”

Jennifer S. Gass, MD
JAMA Surg. 2013;148(5):439. doi:10.1001/jamasurg.2013.140.
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Natural orifice transluminal endoscopic surgery capitalizes on the body's established passageways as routes for surgical organ manipulation. Intuitively using a patent avenue to approach disease ought to incur fewer of the perpetual surgical complications of infection, bleeding, and pain. Minimal access surgeons have used natural cavities as arenas for surgical manipulation, although they require entry through the skin and muscular wall. While incisions are small, 5 to 10 mm, they cause pain and have the attendant risks of surgery, including that of postoperative hernia. To move beyond these hurdles, natural orifice transluminal endoscopic surgery has been used for entry into the peritoneum. Work by Solomon et al1 suggests that while the operative time may be longer with the transvaginal approach for cholecystectomy, postoperative pain in particular is less. The challenge seems to be convincing the patients, given perceptions of complications, sexual function, and fertility, with only 41% of women considering the transvaginal approach as an option for cholecystectomy in a recent Mayo Clinic survey of 409 women.2 These patients voiced fear of complications, pain, infection, and recovery time and concern for the technical aspect of the approach, while in the current studies3,4 the concerns related to sexuality, especially in younger women.

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