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

Gass JS. — Wed, 01 May 2013 00:00:00 GMT

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 al 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. These patients voiced fear of complications, pain, infection, and recovery time and concern for the technical aspect of the approach, while in the current studies the concerns related to sexuality, especially in younger women.

Transvaginal Cholecystectomy Effect on Quality of Life and Female Sexual Function Transvaginal Cholecystectomy

Wood SG, Solomon D, Panait L, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

Transvaginal cholecystectomy (TVC) is the leading natural orifice transluminal endoscopic surgery to date and has the potential to offer improved cosmesis, less pain, and shorter recovery times for female patients.

Objective

To investigate quality of life and female sexual function in our patients undergoing TVC.

Design

A prospective cohort study from August 14, 2009, to June 12, 2012, of TVCs performed at our institution to date.

Setting

Tertiary academic referral center.

Participants

The first 47 consecutive female patients (aged 18-65 years) who received a TVC by a single surgeon.

Interventions

A hybrid TVC was performed by a 5-mm umbilical trocar and a 12-mm transvaginal trocar with standard laparoscopic instruments.

Main Outcomes and Measures

Quality-of-life index (36-Item Short Form Health Survey) and female sexual function (Female Sexual Function Index) scores.

Results

A total of 47 TVCs were performed, with a mean age of 39 years, mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 31, and mean operative time of 65 minutes. No difference was noted in overall female sexual function from preoperatively to 1 and 3 months postoperatively. When comparing quality of life preoperatively vs 1 and 3 months postoperatively, there were significant improvements in physical function (P = .02), energy and fatigue (P = .001), emotional well-being (P = .01), pain (P < .001), and general health (P = .03). No significant changes were noted in physical limitations (P = .18), emotional problems (P = .72), and social function (P = .12).

Conclusions and Relevance

In our experience to date, female sexual function is unchanged and quality of life either is unchanged or improves at 1 and 3 months following TVC. Undergoing TVC does not appear to negatively affect female sexual function or quality of life in the short term.

AMA Publishing Group: Hepato-pancreatico-biliary Surgery Topic Collection

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

Transvaginal Cholecystectomy Effect on Quality of Life and Female Sexual Function Transvaginal Cholecystectomy