Q) Regarding minimal access cholecystectomy all are true except?
a) NOTES can be done transvaginally and transgastrically
b) Transgastric route is preferred
c) SILS is done through single port with multiple instruments avoiding multiple ports
d) SILS has difficulty with triangulation and retraction
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Answer is B
Natural orifice transluminal endoscopic surgery (NOTES), which uses natural orifices (transgastric, colonic, urethral, vagina) to introduce an endoscope, has been reported since early 2000 as a less invasive approach to laparoscopy. The first human NOTES transvaginal cholecystectomy was reported in 2007, and later the report of a hybrid combination of flexible scope by a transvaginal approach in combination with an umbilical needle or port for laparoscopic instruments for retraction, dissection, or clips application. This hybrid technique allowed for a quicker and safer procedure; the present deficiency is in the proper endoscopic instrumentation. For the trans vaginal approach, a Foley catheter is placed, a dissection is performed in the posterior vaginal cul-de-sac to allow a port placement, and when the case is over, the closure is easier than a transgastric or transcolonic approach, which continues to be an issue.