NOTES Transvaginal Cholecystectomy and Appendectomy
NOTES Transvaginal Cholecystectomy and Appendectomy
Natural Orifice Translumenal Endoscopic Surgery (NOTES) is considered by many leading expert
 surgeons to be the next step in MIS (Minimally Invasive Surgery). This is a rapidly evolving
 area of preclinical research and several groups worldwide are developing this surgical
 approach together with industry support. In this new surgical technique, abdominal operations
 are performed using the oropharynx, rectum, or vagina as the ports of entry to the peritoneal
 cavity instead of incisions on the abdominal wall. NOTES offers all the advantages of
 minimally invasive surgery (MIS) and also completely eliminates trauma to the abdominal wall
 and the numerous complications of abdominal wall incisions. A NOTES procedure eliminates any
 visible scar and could also potentially reduce post operative pain due to the elimination of
 abdominal wall trauma.

 In this trial we intend to operate healthy women who need to undergo cholecystectomy or
 appendectomy. The operations will be performed through the vagina as the access port to the
 peritoneum and it will be monitored with laparoscopic vision for safety reasons.
Inclusion Criteria for group #1 Transvaginal cholecystectomy:

 1. Females between the ages of 18 and 50

 2. Diagnosis of gallstone disease which requires cholecystectomy

 3. ASA class 1

 Exclusion Criteria for group #1 Transvaginal cholecystectomy:

 1. Pregnant women

 2. Morbidly obese patients (BMI > 35)

 3. Patients who are taking immunosuppressive medications and/or immunocompromised

 4. Patients with severe medical comorbidities will be excluded.

 5. Patients with a presumed gallbladder polyps, mass or tumor

 6. Patients with a history of prior open abdominal or transvaginal surgery.

 7. Patients with a prior history of peritoneal or vaginal trauma

 8. Patients with a history of ectopic pregnancy, pelvic inflammatory disease, or severe
 endometriosis

 9. Patients with known common bile duct stones

 10. Patients on blood thinners or aspirin or abnormal blood coagulation tests

 Inclusion Criteria for group #2 Transvaginal appendectomy:

 1. Clinical diagnosis of appendicitis

 2. Emergency room evaluation within 36 hours of the onset of pain

 3. ASA Classification

 Exclusion Criteria for group #2 Transvaginal appendectomy:

 1. pregnant women

 2. Morbidly obese patients (BMI >35)

 3. Patients who are taking immunosuppressive medications or are immunocompromised

 4. Patients with evidence of an abdominal abscess or mass

 5. Patients who present with a clinical diagnosis of sepsis or peritonitis

 6. Patients who have a history of prior open abdominal surgery or prior transvaginal
 surgery.

 7. Patients who endorse a history of ectopic pregnancy, pelvic inflammatory disease
 (PID), or severe endometriosis

 8. Patients with diffuse peritonitis on clinical exam

 9. Previous trauma to the perineal area

 10. Patients on blood thinners or aspirin or abnormal blood coagulation tests