Natural orifice transluminal endoscopic surgery (hybrid) cholecystectomy: The Dhillon technique

INTRODUCTION: This study presents a novel technique to perform cholecystectomy and assess its outcome and feasibility. PATIENTS AND METHODS: This study presents the novel Dhillon technique and experience of hybrid natural orifice transluminal endoscopic surgery (NOTES) technique, that is, laparoscopic-assisted transvaginal cholecystectomy. We have evaluated the outcomes in terms of cosmesis, post-operative recovery and analgesic requirement. The study included 257 patients who underwent hybrid NOTES cholecystectomy at single tertiary hospital. The biographical data, surgical time, pain score on day 1 and 2, need of analgesia, intra- and post-operative complication and aesthetic assessment on day 7 were recorded. RESULTS: Out of a total of 1100 cases of laparoscopic cholecystectomy 257 had hybrid NOTES cholecystectomy. Only two of these cases were converted to standard laparoscopic cholecystectomy. The mean operative time was 31.5 +/- 5.1 (25-40) min. None of the patients had any complication or biliary leakage. The mean pain score on day 1 and 2 was 3.6 +/- 0.4 (3-4) and 1.0 +/- 0.06 (1-2), respectively. The mean paracetamol (analgesic) dose requirement was 6.1 +/- 0.6 (4-6.9) g. The aesthetic score was excellent in all the cases. CONCLUSIONS: Using the present technique of hybrid NOTES is beneficial in terms of cosmetic results, lesser need of analgesic and shorter hospital stay.