Natural Orifice Transluminal Endoscopic Surgery (NOTES) is being investigated as an alternative to laparoscopy. Traditional endoscopes are limited in the amount of opposing traction they can apply, and transgastric NOTES cholecystectomy is complicated by paradoxical motion encountered with scope retroflexion. In a porcine model using a novel dual elevator endoscope, our lab has performed transcolonic NOTES cholecystectomy.

Female swine were fasted and given an oral bowel preparation. A colostomy was made in the anterior colon using needle knife cautery and bluntly dilated over a guidewire with the endoscope. The gallbladder fundus was retracted with a transabdominal T-fastener. Instruments passed through 90 degree opposing endoscope elevators were used to expose, ligate, and divide the cystic duct and artery and dissect the gallbladder from the liver.

Transcolonic abdominal access was accomplished in under ten minutes and allowed easy gallbladder visualization without paradoxical motion. Cholecystectomy with gallbladder retrieval was successfully performed in within 2.5 hours.

Experimental transcolonic NOTES cholecystectomy is a feasible procedure that avoids paradoxical instrument motion. Novel endoscopic instrumentation allowing enhanced biplanar tissue traction facilitates surgical dissection techniques.