Transgastric Ultra-Slim Endoscopic Tunneling NOTES for Gallbladder Preservation: Comparative Study With Conventional Technique.

BACKGROUND

To compare the clinical outcomes of transgastric natural orifice transluminal endoscopic surgery (NOTES) using an ultrathin flexible endoscopic tunneling technique with conventional flexible endoscopic NOTES for gallbladder-preserving treatment of gallstones and polyps.

METHODS

A retrospective study was conducted on 62 patients treated between January 2023 and February 2025 at the Fifth People's Hospital of Shenyang, including 23 in the ultrathin tunneling group and 39 in the conventional group. Clinical outcomes, operative time, blood loss, titanium clip usage, postoperative pain (VAS scores), time to flatus, oral intake, hospital stay, costs, complications, clinical success, and recurrence rates were compared. Follow-up was conducted for 1 to 3 months (median: 2 mo).

RESULTS

Both procedures demonstrated a 100% clinical success rate. The ultrathin tunneling group showed significantly lower blood loss, fewer clips, lower VAS scores on postoperative days 1 to 3, earlier oral intake, and shorter hospital stays ( P <0.05). No significant differences were observed in operative time, flatus time, hospitalization costs, complication rates, or gallstone recurrence rates ( P >0.05). Operative time correlated with blood loss, and flatus time correlated with the day 1 VAS score.

CONCLUSIONS

Both NOTES techniques are effective and safe for gallbladder-preserving treatment of gallstones and polyps. The ultrathin tunneling approach offers advantages in reducing surgical trauma, enhancing recovery, and potentially lowering recurrence risk, supporting its clinical application.