In this video, we show a representative example of NOTES cholecystectomy by transgastric and transvesical combined approach, in which feasibility was demonstrated in 7 female pigs. Thus, transgastric access was achieved after perforation and dilatation of the gastric wall with a needle knife and with a balloon, respectively. Under cystoscopic control, a ureteral catheter, a guidewire, and a dilator of the ureteral sheath were used to place a transvesical 5mm overtube into the peritoneal cavity. By using a gastroscope positioned transgastrically and a ureteroscope positioned transvesically, we carried out cholecystectomy in all animals. The transgastric and transvesical combined approach revealed feasible and particularly useful to perform cholecystectomy through exclusive natural orifices.

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