Conclusion: Although difficult technically, LC can be performed safely in patients with AC of up to 7 days duration. It reduces cost of treatment in the sub group of patients

whose duration of check details symptom is more than 4 days. Key Word(s): 1. lap cholecystectomy; 2. acute cholecystitis; 3. duration 4 days; 4. 4 days to 7 days; Presenting Author: BING-RONG LIU LIU Additional Authors: XIAN-CHAO KONG, GUANG-XING CUI, JI-TAO SONG Corresponding Author: BING-RONG LIU LIU Affiliations: the Second Affiliated Hospital of Harbin Medical University; The Second Affiliated Hospital Of Harbin Medical University Objective: Natural orfice transluminal endoscopic surgery (NOTES) is an innovative procedure that represents a further evolvement of minimally

invasive surgery. To our knowledge, pure transgastric NOTES for adnexal procedures has not been reported yet in human beings. Here we report the first clinical application of pure transgastric NOTES for adnexal diseases and evaluate its feasibility and safety. Methods: A 36-year-old woman presented with the symptoms of vaginal bleeding 20 days and left lower abdominal pain 3 days. The serum beta-human chorionic gonadotropin (β-hCG) was 547.23 mIU/ml (normal less than 5 mIU/ml). Transvaginal ultrasonography confirmed the diagnosis with left fallopian tubal ectopic pregnancy and right simple ovarian cyst. A pure transgastric MK-1775 purchase NOTES was performed after approved by the hospital ethical committee. The operation process was as follows:(1) Creation of gastric access by using PEG-like technique; (2) Establishing pneumoperitoneum with a 8 Fr abdominal drainage catheter which was placed on the right lower abdomen and connected to a laparoscopic insufflator; (3) detection of bilateral adnexa: a superficial endometriosis lesion was occasionally found on the right ovarian surface. The ectopic pregnancy mass and ovarian cyst were observed; (4) Cystotomy of the ovarian cyst with Hook knife; (5) Electrical cautery of the endometriosis 上海皓元 lesion with Coagrasper; (6) Salpingostomy and dissection of the ectopic pregnancy

lesion from the tubal wall with Hook knife and IT knife without laparoscopic assistant; (7) Removal of the lesion and observation of no remnant; (8) Closure of the gastric incision with endoclips and nylon loops. Results: The patient did well postoperatively without any complications. Serumβ-hCG returned to normal 3 day after the operation. The histological examination confirmed the presence of chorionic villus in the specimen. Follow-up endoscopy on the 5th postoperative day showed well healing of the gastric incision. Conclusion: Our initial practice indicates that pure transgastric NOTES is feasible and safe in performing adnexal procedures in selected patients. Key Word(s): 1. NOTES; 2. pure NOTES; 3.