Transvaginal laparoscopic cholecystectomy using a single port approach.

Experimental and preliminary clinical cases

Gerhard F. BuessUniversity of Tuebingen

Transvaginal laparoscopic operation based on TEM

1994-1995 first culdoscopic hysterectomy and adnexectomy using TEM instruments

Dr. Todorow, Bayreuth, Germany

Transabdominal laparoscopic surgery based on TEM

beginning of the 1990s

performance of cholecystectomies in different German hospitals

Drivers of changeGoal of single port surgery R&D: flexible multifunctional devices with tools for diagnosis, surgical manipulation and application of drugs

TransvaginalTransvaginalcholecystectomycholecystectomy

curved instrumentscurved instruments

Rotation of shaft

Rotation of instrument tip

Design of an experimental prospective documented Trial

Three surgeons, 30 cases each Subject A: Between 75 and 100 laparoscopic

cholecystectomies experience

Subjects B and C: Professors in surgery, well over 200 cholecystectomies, extensive experience in endoscopic surgery.

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Procedure number

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Subject A Subject B Subject CLog. (Subject A) Log. (Subject B) Log. (Subject C)

Time per procedure

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Group of 15 cases

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Lower grade injury

Higher grade injury

P<0,05*Groups of 15 cases

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1 2 3 4 5 6

Group of 15 cases

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Lower grade injury

Higher grade injury

Groups of 15 cases

Learning curve by type of mistake

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Minor mistakes

Major mistakes

Statistically significant

Transvaginal cholecystectomy with abdominal view on access - March 25th ’08

Transvaginal cholecystectomy - carcinoma - March 29th ’08

Transvaginal cholecystectomy - instrument rotation - March 26th ’08