Needloscopy-assisted transvaginal cholecystectomy.

The reasons for hybrid surgery are various: endoscopic peritoneoscopy under laparoscopic visualization provides a safe way to improve pure natural orifice endoscopic surgery with less abdominal incision. Herein we are presenting a hybrid technique composed of advantages of needloscopy and natural orifice transluminal endoscopic surgery (NOTES). Two women with symptomatic cholelithiasis have undergone successful needloscopy-assisted transvaginal cholecystectomies. Main principle of this approach is the ability of performing cholecystectomy procedure same as in standard laparoscopic cholecystectomy. In contrast, we get benefit of less abdominal trauma due to transvaginal endoscopic exposure, clipping maneuver, and removal of gallbladder. We believe that, trend of more minimal invasive surgery which created the idea of NOTES, gets benefit from hybrid techniques as an interval step toward NOTES when waiting for the ideal equipment and sufficient experience.