Transvaginal laparoscopic cholecystectomy (hybrid NOTES cholecystectomy).

Natural orifice transluminal endoscopic surgery (NOTES) is usually performed by using a flexible endoscope. However, this instrument shows several limitations in the manipulation of intra-abdominal organs. Using the laparoscope instead of the flexible endoscope eliminates the need for new instruments and technical skills. We used conventional laparoscopic instruments for improving operative efficiency and single-port access (SPA) to prevent air leakage from the vaginal port. A 54-year-old female patient was admitted to our hospital with uterine prolapse and symptomatic gallstones. She underwent a transvaginal laparoscopic cholecystectomy. The transvaginal hysterectomy was performed after the cholecystectomy by a gynecologist. The operative time for the cholecystectomy was 86 minutes. She was discharged on postoperative day 8. This technique combines the advantages of NOTES and SPA surgery. We think that this technique can be easily performed from using laparoscopic instruments.