OBJECTIVENatural Orifice Transluminal Endoscopic Surgery (NOTES) may further already accepted benefits of minimally invasive surgery. To date, little is known regarding intra-operative cardiopulmonary risks of NOTES. The aim of this study is to compare intra-operative cardiopulmonary parameters in transvaginal versus laparoscopic cholecystectomy. METHODS: A retrospective case-controlled comparison study was performed at a single University tertiary care institution. Ten consecutive women who had transvaginal cholecystectomy between January 2007 and July 2008 were matched by age and body mass index to ten women who underwent laparoscopic cholecystectomy during the same time period. All surgeries were performed by the same surgeon with a standardized technique. Primary outcome measures were the noninvasive cardiopulmonary parameters: mean arterial pressure, heart rate, and end tidal CO2 (ETCO2). Secondary outcome measures were operation duration and hospital length of stay.RESULTS: All operations were successfully completed. Two patients intending to undergo transvaginal cholecystectomy instead underwent laparoscopic cholecystectomy due to significant adhesions. These patients were excluded from the study. No respiratory compromise requiring desufflation occurred in either groupMean operative times were higher in the NOTES group (97.7+/-21.9 min) compared to the laparoscopic group (72.3 +/- 10.8 min; p=.015). All patients in both groups were discharged on post-operative day 1. CONCLUSION: In this study, favorable differences in pulse rate and ETCO2 were observed in transvaginal cholecystectomy compared to laparoscopic cholecystectomy. Without another explanation for these findings, we speculate this may be due to decreased pain and/or trauma from the NOTES approach. There was no statistically significant difference in MAP between the two groups. There were no detrimental intra-operative hemodynamic or respiratory changes identified during transvaginal cholecystectomy compared to laparoscopic cholecystectomy. Although the average operative time for a transvaginal cholecystectomy was longer than laparoscopic cholecystectomy, there was a trend toward decreasing operative times as additional transvaginal cases were performed
Transvaginal vs Laparoscopic Cholecystectomy

Parameter	NOTES	Laparoscopy	p-value
ETCO2	3.55 ± 3.0 mmHg	6.55 ± 3.0 mmHg	P = 0.01
PIP	7.88± 3.48 mmHg	8.88 ± 3.0 mmHg	p = 0.43
MAP	15.2 ± 16.04 mmHg	17 ± 5.36 mmHg	p = 0.77
Pulse	-1.44± 6.59 mmHg	10.8 ± 7.9 mmHg	p = 0.003