Conclusion: This first country-wide ERCP survey shows that small number of cases is performed by majority of ERCPists. The use of diagnostic ERCPs and inadequate infection control measures are other major concerns. Key Word(s): 1. ERCP; 2. National Survey; Presenting Author: P S RAJAN Additional Authors: C PALANIVELU, S RAJAPANDIAN, Doxorubicin manufacturer P PRAVEEN RAJ Corresponding Author: P S RAJAN Affiliations: GEM Hospital & Research Centre; GEM Hospital & Research Centre; GEM Hospital & Research Centre; GEM Hospital & Research Centre Objective: Natural orifice trans

luminal endoscopic surgery (NOTES) represents an emerging technology with variety of approaches and combinations. While performing cholecystectomy, we had encountered many a times wide cystic duct not amenable for clipping with available endo clips. Our objective was to test the feasibility of retrograde cholecystectomy with application of endo loop to cystic duct in few selected cases. Methods: From August 2010 to December 2012, total of 18 patients were scheduled to undergo trans vaginal endoscopic cholecystectomy at our institiute. 4 patients during surgery found to have wide cystic duct difficult for clipping and hence tried retrograde dissection of gall bladder

starting from fundus and after completely freeing gall bladder and cystic RG7204 in vitro duct, two catgut endo loops applied to cystic duct and divided in between. Results: Total number of patients for retrograde cholecystectomy : 4. Number of abdominal ports : 3 mm trocar at umbilicus and 5 mm trocar at right lumbar. Mean operative time : 90 minutes. Patients were discharged on third post operative day. Conclusion: In our technique, we used 3 mm trocar at umbilicus to assist entry and exit of endoscope, maintaining pneumo peritoneum and retracting the fundus of gall bladder.

The 5 mm right lumbar trocar helped to retract liver while doing dissection retrogradely 上海皓元医药股份有限公司 and also to keep sub hepatic drain through it. The endo loop used was conventional chromic catgut passed through working channel of endoscope. The retrograde dissection avoids expensive endo clips, able to complete difficult cases with wide cystic duct and also in difficult Calot?s anatomy. We feel trans vaginal approach to difficult cholecystectomy be retrograde technique is safe and feasible. Key Word(s): 1. NOTES; 2. Transvaginal; 3. Retrograde; 4. Cholecystectomy; Presenting Author: P S RAJAN Additional Authors: C PALANIVELU, S RAJAPANDIAN, R PARTHASARATHI Corresponding Author: P S RAJAN Affiliations: GEM Hospital & Research Centre Objective: Natural orifice transluminal endoscopic surgery (NOTES) is a surgical procedure to be performed by endoscopic accessories via natural orifices like mouth, anal canal and vagina in females. With any transition from standard laparoscopy to newer approach, the results of the newer procedure should be with lesser morbidity. Hence we adopted step by step approach.