less pain after transvaginaltransumbilical cholecystectomy than after the classical laparoscopic technique shortterm results of a matchedcohort study background natural orifice surgery nos is gaining acceptance as an alternative to the traditional laparoscopic technique especially for cholecystectomy through the transvaginal route however nos remains controversial concerning expected advantages in terms of short and longterm outcomes and potential side effects this study was designed to compare shortterm outcomes between transvaginaltransumbilical and classical laparoscopic cholecystectomy lcmethods a prospective matchedcohort study compared the authors first 50 transvaginaltransumbilical cholecystectomies tvc with a group of 50 classical lcs from the corresponding period matched in terms of age body mass index and american society of anesthesiology classification in both groups elective surgery was performed for symptomatic cholecystolithiasis in the nos group a hybrid procedure was performed with one transumbilical rigid instrument and two transvaginal rigid instruments a numeric rating scale was used for daily pain assessment initiated postoperatively in the recovery room both groups were compared with regard to length of surgery intra and postoperative complications length of hospital stay postoperative pain and consumption of analgesicsresults the length of surgery and the rate of complications were similar in the two groups but significant advantages were found for the transvaginal access in terms of pain using numeric rating scale nrs on the day of surgery nrs 1510 vs 3110 p 0003 as well as in the morning nrs 1910 vs 2810 p 0047 and in the evening nrs 1110 vs 1810 p 0025 of postoperative day 1 and with regard to the length of the postoperative hospital stay 27 vs 34 days p 0035conclusions the findings show that tvc is a safe procedure for female patients it has a risk comparable with that of classic lc causes significantly less pain in the early postoperative period and leads to a significantly shorter hospital stay prospective randomized trials are necessary to confirm these results