Cholecystectomy
Gallstones affect an estimated 20.5 million people in the U.S.25 Cholecystectomy (gall bladder removal) is among the top 10 procedures most frequently performed in U.S. hospitals annually, and biliary tract disease has been estimated to cost U.S. healthcare $5 billion/year.26 Cholecystectomy is one of the most frequently performed operations and open cholecystectomy has been the gold standard for over 100 years. Laparoscopic cholecystectomy was introduced in the 1980s. There are more than 1 million laparoscopic cholecystectomy procedures performed annually in the U.S.A.28
Laparoscopic gall bladder surgery, which requires about 4 to 5 small cuts into the abdomen, emerged as a less invasive, safer (overall operative mortality decreased 33 percent28) treatment option and quickly began to replace traditional open gall bladder removal surgery.
In the summer of 2007, surgeons advanced minimally invasive gall bladder surgery further by using the USGI EOS to perform the first hybird transgastric and transvaginal cholecystectomy procedures in the U.S.
Innovative surgeons and surgical endoscopists have developed the means to surpass the constraints of the natural orifices and gastrointestinal lumens by using flexible endoscopic devices instead of rigid laparoscopic devices. The clinical need described in case reports and in the scientific literature include the need for appropriate selection of access points; effective closure of the incision into the intestine, vaginal, or abdominal wall; innovative instruments; and a stable platform for improved flexible endoscopic maneuvers. The need to replace rigid laparoscopic instruments with flexible devices makes manipulating solid organs a challenge and creates the clinical need of a stable platform. Available conventional endoscopes were used for most of the NOTES cases described in the literature and losing orientation is an additional challenge, which further complicates the flexible surgery approach.