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Is Natural Orifice Transluminal Endoscopic Cholecystectomy as Safe as Laparoscopic Cholecystectomy?

Robert C. Hall, MD
Arch Surg. 2008;143(6):604. doi:10.1001/archsurg.143.6.604-a.
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In the September 2007 issue of Archives, a French group published the article “Surgery Without Scars: Report of Transluminal Cholecystectomy in a Human Being.”1 Their patient experienced “scarless” surgery, scant discomfort, and immediate return to activity. In contrast, laparoscopic cholecystectomy involves 4 small abdominal scars with mild pain lasting a few weeks. However, natural orifice transluminal endoscopic surgery (NOTES) adds hazards, the most serious being the risk of peritonitis due to leaks from the stomach or other access organs. Even with the ingenious closure techniques being developed in animals,2 we know leaks will occur. In their 2006 white paper on NOTES, the authors stated, “A 1% leak rate is not acceptable,” while acknowledging that leaks would be “inevitable (even if rare).”3 If the rate reached only a quarter of a percent (0.25%), with 750 000 cholecystectomies annually, NOTES would still cause 1875 people to go through a second operation and to protest, “The small gain in comfort, cosmesis, and activity was not worth it.”

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