Background and study aims: Animal data and limited clinical evidence suggest a low incidence of infection following
transvaginal natural orifice transluminal endoscopic surgery (NOTES). However, a systematic
microbiological evaluation has not yet been carried out. The aim of this prospective
cohort study was to evaluate the extent of microbiological contamination of the peritoneal
cavity caused by the transvaginal access for NOTES and the impact of preoperative
vaginal disinfection on vaginal colonization.
Patients and methods: Consecutive female patients with symptomatic cholecystolithiasis were offered either
transvaginal rigid-hybrid cholecystectomy (tvCCE) or conventional laparoscopic cholecystectomy.
Patients who opted for tvCCE were prospectively evaluated between February and June
2010. Disinfection in patients undergoing tvCCE included hexetidine tablets and octenidine
applied vaginally. All patients received a single dose of perioperative cefuroxime.
Swabs were obtained from the posterior fornix and the peritoneal cavity at different
intervals.
Results: Of 32 patients, 27 (84 %) opted to undergo tvCCE. One patient (4 %; 95 % confidence
interval [CI] 0.7 % – 18.3 %) had a positive bacterial culture in the Douglas pouch
prior to transvaginal access compared with two patients (7 %; 95 %CI 2.1 % – 23.4 %)
following colpotomy closure (P = 1.000). Vaginal disinfection significantly decreased vaginal bacterial load (P = 0.001) and bacterial growth in routine cultures (P < 0.001); in 16 patients (59 %; 95 %CI 40.7 % – 75.5 %) vaginal swabs were sterile
after disinfection. No postoperative surgical site infections occurred (95 %CI 0 % – 12.5 %).
Conclusions: In selected patients and following vaginal antisepsis, transvaginal access for NOTES
is associated with microbiological contamination of the peritoneal cavity in a minority
of patients, indicating a low risk of peritoneal contamination caused by the transvaginal
access.
