Hybrid NOTES cholecystectomy - A safe and economic innovation

Background: Minimally invasive techniques have revolutionized surgery, making great impact in terms of reduced postoperative morbidity and shorter hospital stay by reducing abdominal wall trauma. Recent introduction of single incision laparoscopic surgery has introduced another debate. After establishing safety profile at the local level, we now present another modification of single incision cholecystectomy. Findings: These procedures were performed on two female patients diagnosed with gallstone disease and scheduled to undergo elective single incision laparoscopic surgery (SILS). Standard laparoscopic ports, straight laparoscopic instruments and 5mm 30° scopes were used. The scope was inserted per vaginum using a long 5mm laparoscopic port. The operation was performed using two instruments introduced through the umbilicus using two standard 5mm laparoscopic ports. The 5mm umbilical fascial defects did not require formal closure. No intra-operative or postoperative complication was reported. Operation was made technically easy because this modification provided greater flexibility of movement for operating instruments by decreasing crowding at the umbilical port without compromising on postoperative recovery or cosmetics. Conclusion: The use of laparoscope through vagina is a viable and safe modification of single incision laparoscopic surgery.