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Erschienen in: Langenbeck's Archives of Surgery 4/2013

01.04.2013 | Original Article

Long-term results of transvaginal/transumbilical versus classical laparoscopic cholecystectomy—an analysis of 88 patients

verfasst von: Dirk R. Bulian, Linda Trump, Jürgen Knuth, Nicola Cerasani, Markus M. Heiss

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 4/2013

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Abstract

Introduction

Transvaginal/transumbilical cholecystectomy using rigid instruments (TVC) is an alternative to the traditional laparoscopic technique (LC). Due to a lack of long-term data, the transvaginal approach is still controversial.

Methods

Our first 50 TVC patients and 50 LC patients from the same time period with the same limits according to age, BMI and ASA classification were asked 48 questions 2 years postoperatively (mean) about resuming sexual intercourse, the domains “satisfaction” and “pain” of the German Female Sexual Function Index, resuming everyday life, postoperative abdominal pain, subjective impairment, incisional hernias, satisfaction with the aesthetic result, the overall postoperative result, and others. Postoperative sexual satisfaction and pain were defined as main outcome. Forty-six TVC patients and 42 LC patients answered the questions (36 TVC patients and 25 LC patients could answer the questions about sexual function).

Results

No significant differences were found for postoperative sexual function, change in menorrhea, vaginal discharge and postoperative abdominal pain. TVC patients felt significantly less impaired postoperatively (p = 0.034). Two patients in the LC group developed a trocar hernia (p = 0.225). TVC patients could resume everyday life significantly earlier (p < 0.001) and were significantly more satisfied with the aesthetic (p < 0.001) and the overall postoperative result (p = 0.001). Significantly more TVC patients would recommend the applied surgical technique to friends and family (p < 0.001).

Conclusions

This long-time prospective data acquisition from 88 or, for some data, 61 patients accounts for the safety of TVC, particularly with regard to sexual function. Additionally, it found less postoperative impairment, quicker recovery and improved satisfaction for TVC as compared to LC.
Literatur
1.
Zurück zum Zitat Lehmann KS, Ritz JP, Wibmer A, Gellert K, Zornig C, Burghardt J, Busing M, Runkel N, Kohlhaw K, Albrecht R, Kirchner TG, Arlt G, Mall JW, Butters M, Bulian DR, Bretschneider J, Holmer C, Buhr HJ (2010) The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Ann Surg 252(2):263–270. doi:10.1097/SLA.0b013e3181e6240f PubMedCrossRef Lehmann KS, Ritz JP, Wibmer A, Gellert K, Zornig C, Burghardt J, Busing M, Runkel N, Kohlhaw K, Albrecht R, Kirchner TG, Arlt G, Mall JW, Butters M, Bulian DR, Bretschneider J, Holmer C, Buhr HJ (2010) The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Ann Surg 252(2):263–270. doi:10.​1097/​SLA.​0b013e3181e6240f​ PubMedCrossRef
3.
Zurück zum Zitat Strickland AD, Norwood MG, Behnia-Willison F, Olakkengil SA, Hewett PJ (2010) Transvaginal natural orifice translumenal endoscopic surgery (NOTES): a survey of women’s views on a new technique. Surg Endosc 24(10):2424–2431. doi:10.1007/s00464-010-0968-3 PubMedCrossRef Strickland AD, Norwood MG, Behnia-Willison F, Olakkengil SA, Hewett PJ (2010) Transvaginal natural orifice translumenal endoscopic surgery (NOTES): a survey of women’s views on a new technique. Surg Endosc 24(10):2424–2431. doi:10.​1007/​s00464-010-0968-3 PubMedCrossRef
4.
Zurück zum Zitat Bucher P, Ostermann S, Pugin F, Morel P (2011) Female population perception of conventional laparoscopy, transumbilical LESS, and transvaginal NOTES for cholecystectomy. Surg Endosc 25(7):2308–2315. doi:10.1007/s00464-010-1554-4 PubMedCrossRef Bucher P, Ostermann S, Pugin F, Morel P (2011) Female population perception of conventional laparoscopy, transumbilical LESS, and transvaginal NOTES for cholecystectomy. Surg Endosc 25(7):2308–2315. doi:10.​1007/​s00464-010-1554-4 PubMedCrossRef
7.
Zurück zum Zitat Bulian DR, Trump L, Knuth J, Siegel R, Sauerwald A, Strohlein MA, Heiss MM (2012) Less pain after transvaginal/transumbilical cholecystectomy than after the classical laparoscopic technique: short-term results of a matched-cohort study. Surg Endosc. doi:10.1007/s00464-012-2490-2 Bulian DR, Trump L, Knuth J, Siegel R, Sauerwald A, Strohlein MA, Heiss MM (2012) Less pain after transvaginal/transumbilical cholecystectomy than after the classical laparoscopic technique: short-term results of a matched-cohort study. Surg Endosc. doi:10.​1007/​s00464-012-2490-2
8.
Zurück zum Zitat Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R Jr (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26(2):191–208. doi:10.1080/009262300278597 PubMedCrossRef Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R Jr (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26(2):191–208. doi:10.​1080/​009262300278597 PubMedCrossRef
9.
Zurück zum Zitat Berner MM, Kriston L, Zahradnik HP, Härter M, Rohde A (2004) Validity and reliability of the German Female Sexual Function Index (FSFI-d). Geburtsh Frauenheilk 64:293–303. doi:10.1055/s-2004-815815 CrossRef Berner MM, Kriston L, Zahradnik HP, Härter M, Rohde A (2004) Validity and reliability of the German Female Sexual Function Index (FSFI-d). Geburtsh Frauenheilk 64:293–303. doi:10.​1055/​s-2004-815815 CrossRef
10.
Zurück zum Zitat Hensel M, Schernikau U, Schmidt A, Arlt G (2011) Surgical outcome and midterm follow-up after transvaginal NOTES hybrid cholecystectomy: analysis of a prospective clinical series. J Laparoendosc Adv Surg Tech 21(2):101–106. doi:10.1089/lap.2010.0508 CrossRef Hensel M, Schernikau U, Schmidt A, Arlt G (2011) Surgical outcome and midterm follow-up after transvaginal NOTES hybrid cholecystectomy: analysis of a prospective clinical series. J Laparoendosc Adv Surg Tech 21(2):101–106. doi:10.​1089/​lap.​2010.​0508 CrossRef
11.
12.
Zurück zum Zitat Zornig C, Mofid H, Siemssen L, Emmermann A, Alm M, von Waldenfels HA, Felixmuller C (2009) Transvaginal NOTES hybrid cholecystectomy: feasibility results in 68 cases with mid-term follow-up. Endoscopy 41(5):391–394PubMedCrossRef Zornig C, Mofid H, Siemssen L, Emmermann A, Alm M, von Waldenfels HA, Felixmuller C (2009) Transvaginal NOTES hybrid cholecystectomy: feasibility results in 68 cases with mid-term follow-up. Endoscopy 41(5):391–394PubMedCrossRef
13.
14.
Zurück zum Zitat Linke GR, Tarantino I, Hoetzel R, Warschkow R, Lange J, Lachat R, Zerz A (2010) Transvaginal rigid-hybrid NOTES cholecystectomy: evaluation in routine clinical practice. Endoscopy 42(7):571–575. doi:10.1055/s-0029-1244159 PubMedCrossRef Linke GR, Tarantino I, Hoetzel R, Warschkow R, Lange J, Lachat R, Zerz A (2010) Transvaginal rigid-hybrid NOTES cholecystectomy: evaluation in routine clinical practice. Endoscopy 42(7):571–575. doi:10.​1055/​s-0029-1244159 PubMedCrossRef
15.
Zurück zum Zitat Kilian M, Raue W, Menenakos C, Wassersleben B, Hartmann J (2011) Transvaginal-hybrid vs. single-port-access vs. ‘conventional’ laparoscopic cholecystectomy: a prospective observational study. Langenbecks Arch Surg 396(5):709–715. doi:10.1007/s00423-011-0769-8 PubMedCrossRef Kilian M, Raue W, Menenakos C, Wassersleben B, Hartmann J (2011) Transvaginal-hybrid vs. single-port-access vs. ‘conventional’ laparoscopic cholecystectomy: a prospective observational study. Langenbecks Arch Surg 396(5):709–715. doi:10.​1007/​s00423-011-0769-8 PubMedCrossRef
16.
Zurück zum Zitat Zornig C, Siemssen L, Emmermann A, Alm M, von Waldenfels HA, Felixmuller C, Mofid H (2011) NOTES cholecystectomy: matched-pair analysis comparing the transvaginal hybrid and conventional laparoscopic techniques in a series of 216 patients. Surg Endosc 25(6):1822–1826. doi:10.1007/s00464-010-1473-4 PubMedCrossRef Zornig C, Siemssen L, Emmermann A, Alm M, von Waldenfels HA, Felixmuller C, Mofid H (2011) NOTES cholecystectomy: matched-pair analysis comparing the transvaginal hybrid and conventional laparoscopic techniques in a series of 216 patients. Surg Endosc 25(6):1822–1826. doi:10.​1007/​s00464-010-1473-4 PubMedCrossRef
17.
18.
Zurück zum Zitat Linke GR, Tarantino I, Bruderer T, Celeiro J, Warschkow R, Tarr PE, Muller-Stich BP, Zerz A (2012) Transvaginal access for NOTES: a cohort study of microbiological colonization and contamination. Endoscopy. doi:10.1055/s-0032-1309390 Linke GR, Tarantino I, Bruderer T, Celeiro J, Warschkow R, Tarr PE, Muller-Stich BP, Zerz A (2012) Transvaginal access for NOTES: a cohort study of microbiological colonization and contamination. Endoscopy. doi:10.​1055/​s-0032-1309390
19.
Zurück zum Zitat Linke GR, Luz S, Janczak J, Zerz A, Schmied BM, Siercks I, Warschkow R, Beutner U, Tarantino I (2012) Evaluation of sexual function in sexually active women 1 year after transvaginal NOTES: a prospective cohort study of 106 patients. Langenbecks Arch Surg. doi:10.1007/s00423-012-0993-x Linke GR, Luz S, Janczak J, Zerz A, Schmied BM, Siercks I, Warschkow R, Beutner U, Tarantino I (2012) Evaluation of sexual function in sexually active women 1 year after transvaginal NOTES: a prospective cohort study of 106 patients. Langenbecks Arch Surg. doi:10.​1007/​s00423-012-0993-x
20.
Zurück zum Zitat Pugliese R, Forgione A, Sansonna F, Ferrari GC, Di Lernia S, Magistro C (2010) Hybrid NOTES transvaginal cholecystectomy: operative and long-term results after 18 cases. Langenbecks Arch Surg 395(3):241–245. doi:10.1007/s00423-009-0528-2 PubMedCrossRef Pugliese R, Forgione A, Sansonna F, Ferrari GC, Di Lernia S, Magistro C (2010) Hybrid NOTES transvaginal cholecystectomy: operative and long-term results after 18 cases. Langenbecks Arch Surg 395(3):241–245. doi:10.​1007/​s00423-009-0528-2 PubMedCrossRef
21.
Metadaten
Titel
Long-term results of transvaginal/transumbilical versus classical laparoscopic cholecystectomy—an analysis of 88 patients
verfasst von
Dirk R. Bulian
Linda Trump
Jürgen Knuth
Nicola Cerasani
Markus M. Heiss
Publikationsdatum
01.04.2013
Verlag
Springer-Verlag
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 4/2013
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-013-1071-8

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