What Is Transvaginal Cholecystectomy?

Transvaginal cholecystectomy is a surgery in which the gallbladder is removed through the vagina.

Transvaginal cholecystectomy is a novel surgical procedure to remove the gallbladder through the vaginal route.

It is one of the three types of cholecystectomy—apart from the traditional open cholecystectomy and laparoscopic cholecystectomy—that is done to treat patients with an inflamed gallbladder (cholecystitis).

The decision to opt for transvaginal cholecystectomy over the other two methods remains at the discretion of the patient as also on the surgeon’s expertise.

Transvaginal cholecystectomy can be done in either of the two ways:

• Natural orifice transluminal endoscopic surgery (NOTES) alone
• A combination of NOTES and laparoscopy (hybrid NOTES)

The advantages of transvaginal cholecystectomy via NOTES over the other types of cholecystectomy include the following:

• Low chances of infection and hernia
• Less pain after surgery (hence less need for painkillers)
• Shorter recovery period
• No visible scars

A doctor may recommend you against transvaginal cholecystectomy and instead prefer laparoscopic cholecystectomy or open cholecystectomy if you

• Have gangrenous cholecystitis (a deadly complication of cholecystitis)
• Are pregnant
• Have delivered in the last two months
• Have a history of 
  • Pelvic inflammatory disease (PID)
  • Endometriosis (a painful condition in which tissues of the uterus grow anywhere in the abdomen)
  • Inflammatory bowel disease (IBD)
  • Retroflexed or retroverted uterus (tilted uterus)

If complications arise during the surgery, the doctor can decide to convert transvaginal cholecystectomy to either the laparoscopic or open approach.

Before the surgery

• The doctor will evaluate you to know if you are fit for the surgery and general anesthesia. You are not allowed to eat or drink anything for 8-12 hours, except for a few sips of water with the necessary medicines, before the surgery.

During the surgery

• You will be given general anesthesia to make you sleep throughout the procedure.
• The surgeon makes a small incision of about 5 mm on your belly button.
• The surgeon introduces an endoscope/a laparoscope (a long tube-like camera) through the incision to visualize the gallbladder. 
• The surgeon fills the abdominal cavity with air.
• Next, the surgeon introduces an instrument known as a speculum into the vagina to visualize the interior of the vagina and then makes a small incision on the vaginal wall.
• The surgeon inserts another endoscope through the vaginal incision and directs it further to visualize the gallbladder in the abdomen.
• Once the gallbladder is identified, the surgeon cuts it with the help of instruments inserted through the previous endoscope on your belly button. 
• Hemostasis (arresting of bleeding) is achieved.
• The surgeon then removes the gallbladder out of the vaginal route in a retrieval bag. 
• The surgeon cleans the incision at the abdomen and applies a bandage; the surgeon then sutures the vagina.

After the surgery

• You are shifted to the general ward and observed for several hours after the surgery.
• A liquid diet is started after 12-24 hours after the surgery.
• Painkillers and antibiotics are initially given intravenously (IV) and later by mouth.
• After regular monitoring, you are discharged usually after one or two days.
• You need to avoid sex for about two weeks to one month after the surgery as advised.
• Follow-up with the surgeon will be scheduled generally after seven days of your discharge and later as advised.

The uterus is only passed by and remains uninjured, whereas the endoscope moves toward the appendix, so it is unlikely that a cholecystectomy performed with the transvaginal approach will affect your fertility.

The possible complications of transvaginal cholecystectomy include the following:

• Bowel or rectal injury
• Abdominal adhesions (bands of scar-like tissue between two or more organs)
• Abdominal abscess (collection of pus in the abdomen) 

As the gallbladder is located close to the liver and the bile duct, any technique of cholecystectomy carries a risk of

• Injury to the liver and its arteries (injury to the arteries of your liver may lead to internal bleeding).
• Injury to the bile duct (injury to the bile duct may cause the bile to leak into the abdominal cavity giving rise to extreme pain).