Introduction:Laparoscopic cholecystectomy has become standard procedure during the last two decades. Natural orifice transluminal endoscopic surgery (NOTES) will further decrease the operative trauma to the abdominal wall and reduce postoperative pain, wound infection, risk of hernia and hospital stay. We now report the first results of transvaginal Hybrid-NOTES cholecystectomy from Switzerland.Methods und Materials:From July 2008 to October 2008, 4 women were treated by transvaginal Hybrid-NOTES cholecystectomy. Pneumoperitoneum was created through a 5 mm incision in the umbilicus. Two rigid trocars (12 mm and 5 mm) were inserted in the posterior fornix of the vagina. Patient data, operative time, complications and postoperative course were recorded prospectively in each patient. Results:The average age of the 4 patients was 33 years (19 to 44 years) and the mean body mass index was 25.73 kg/m2. One patient had in advance a cesarean section and another patient a conization. In all patients operation was performed without intraoperative complications and no further procedure was done simultaneously. The mean operative time was 77 minutes (65 to 87 minutes). The mean hospital stay was 2.75 days (2 to 3 days). Non steroidal anti-inflammatory drugs and paracetamol or metamizol were administered for postoperative analgesia. The postoperative course was except for little vaginal bleeding in the first 3 to 7 days uneventful. The further postoperative follow-up after 4 weeks was without complications.Discussion:The transvaginal Hybrid-NOTES cholecystectomy is a feasible and safe procedure. Operative time was despite lack of experience not longer than in laparoscopic cholecystectomy. The posterior colpotomy is a simple approach to the abdominal cavity and wound healing is very rapid. Using rigid instruments and techniques which are wellknown from laparoscopy, transvaginal cholecystectomy is possible without other medical specialties.