[Cholecystectomy without visible scars: the transvaginal method].

Since the 1990's, laparoscopic cholecystectomy has been the standard procedure for symptomatic gallstone disease. Natural Orifice Transluminal Endoscopic Surgery (NOTES) is the next logical step in the development of minimal invasive surgery. During a NOTES procedure, a natural orifice is used to gain access to the abdominal cavity instead of incisions through the abdominal wall. In this article we report the introduction of the NOTES technique to the Netherlands. In our institution, 15 women with gallstone disease recently underwent transvaginal cholecystectomy. The procedure performed was a hybrid NOTES cholecystectomy. Only one trocar was inserted through the umbilicus, and two other instruments were inserted through the vagina. The potential advantages of this technique include a better cosmetic result and less postoperative pain. The number and type of complications do not appear to differ from those of the standard laparoscopic cholecystectomy.