Are laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery gallbladder preserving cholecystolithotomy truly comparable? A propensity matched study

Figure 1 Schematic of colonic cleansing, detachable balloon placement, and colonic disinfection. A: Colon after bowel preparations; B: Colon cleansing using saline solution; C: Placement of detachable balloon in the transverse colon; D: Distal colon disinfection using iodophor; E: Endoscopy insertion to peritoneal cavity via rectal incision; F: Suturing of rectal incision before balloon removal.

Figure 2 Natural orifice transluminal endoscopic surgery trans-rectal gallbladder preserving cholecystolithotomy. A: Detachable balloon placement in the colonic lumen; B: Rectum incision for trans-rectal access; C: Gallbladder incision; D: Visualization of gallbladder stones; E: Closure of the gallbladder wall with endoclips; F: Closure of the rectal incision with endoclips and endoloops.

Figure 3 Flow chart of the entire and matched cohort. NOTES: Natural orifice transluminal endoscopic surgery.

Figure 4 The cumulative incidence of recurrent gallbladder stones and recurrent cholecystitis in the natural orifice transluminal endoscopic surgery group. A: Cumulative incidence of recurrent gallbladder stones in natural orifice transluminal endoscopic surgery (NOTES) patients; B: Cumulative incidence of recurrent cholecystitis in the NOTES patients.