Initial experience with laparoscopic-assisted transvaginal cholecystectomy: a hybrid approach to natural orifice surgery.

Minimally invasive surgery is designed to provide a friendlier surgical therapy, in terms of faster recovery times, improved cosmetic results, and reduced postoperative pain. In recent years, a new genre for exploring the abdominal cavity without incisions has been developed. Incisionless surgery is considered the next frontier in minimally invasive surgery. The idea is to use natural orifices as the entry point to the abdomen, by using an endoscope through a transgastric, transvaginal, transvesical, or transcolonic access; hence, it is called as natural orifice transluminal endoscopic surgery (NOTES). We report our first case of laparoscopic-assisted transvaginal cholecystectomy. We support that NOTES can provide benefits in terms of reduced pain, faster recovery, and better cosmetic results compared with conventional laparoscopic surgery.