It has the ring of a “Ripley’s Believe It or Not” story — gallbladders are surgically removed through the mouth… a kidney is taken out via the vagina… a colon is extracted from the rectum. Yet it’s true — these and other natural orifice surgeries have been successfully performed at academic medical centers around the country, including Johns Hopkins University, University of California, San Diego Medical Center and New York Presbyterian Hospital-Columbia University Medical Center, and you’ll undoubtedly be hearing more about such procedures in the future.

These groundbreaking procedures are the latest twist in minimally invasive surgery, which reduces pain, scarring and recovery time. I spoke with Marc Bessler, MD, one of the surgeons who performed the first transvaginal gallbladder removal. Dr. Bessler is director of both the Minimal Access Surgery Center and the Center for Metabolic and Weight Loss Surgery at New York-Presbyterian Hospital/Columbia University Medical Center.

USING “NATURAL OPENINGS”

The trend toward less invasive procedures was evident in the late 1980s with laparoscopic surgery — where doctors thread narrow instruments and cameras into the body, their actions guided by video images displayed on monitors in the operating room. Now surgeons have pushed the envelope even further with natural orifice procedures. Dr. Bessler informed me that natural orifice surgery is still in an early and experimental stage, yet it shows great promise for the future. These revolutionary new procedures are collectively referred to as Natural Orifice Transluminal Endoscopic Surgery (NOTES), or — less scientifically — as “scarless” surgeries.

Dr. Bessler called that first gallbladder removal that he performed through the vagina a “hybrid” operation, since for safety’s sake he also made several small laparoscopic cuts in the patient’s belly. While many natural orifice procedures are still performed this way, Dr. Bessler and a small cadre of fellow pioneer surgeons have now started to do some surgeries through natural body openings without making any external cuts at all.

AVAILABLE PROCEDURES

The most common openings used are the vagina, mouth and anus. In addition to gallbladder operations, other procedures performed through these new routes include sleeve gastrectomy to treat obesity, tubal ligation, kidney and appendix removal, tumor removal and diagnostic evaluations.

Dr. Bessler cautions that while the cosmetic results of natural orifice surgery are a significant plus, since the scars are hidden internally, surgery is still surgery. Whether a surgeon enters the body through the vagina, mouth or rectum, he/she must still cut through internal tissue walls to reach and operate on organs. There will still be pain and recovery time, albeit at the less severe level of laparoscopic surgery rather than that of traditional open procedures. “We hope and many believe that we can achieve pain-free and recovery-free surgery using NOTES,” said Dr. Bessler.

To learn more about this promising new technology, visit the Web site of the Natural Orifice Surgery Consortium for Assessment and Research at http://www.noscar.org. Be aware, however, that although natural orifice procedures have enormous potential, the field is in its infancy and further trials are still being conducted. Dr. Bessler emphasizes that he and other surgeons are in the process of researching, developing, testing and perfecting these new surgical techniques. Far from being widely available, natural orifice procedures are primarily performed on an experimental basis at major surgical centers, and although this is likely to change in the future, few surgeons at present possess the skills and training to undertake them.

Source(s):

Marc Bessler, MD, director of the Minimal Access Surgery Center and director of the Center for Metabolic and Weight Loss Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, assistant professor of surgery, Columbia University College of Physicians and Surgeons, New York City.

Natural Orifice Surgery Consortium for Assessment and Research, http://www.noscar.org.

I’m with you re: Obama. He’s doing the best he can which is better than most of his predecessors’ ‘best’ – just my opinion. WHAT is up around the world, Somalian pirates, Bangkok, North Korea…? Yikes…

Luv, Zen Lill

Sarah Palin’s choice for attorney general once wrote a column defending a statue of a KKK figure as an expression of free speech on a college campus and mocked the psychology of a fellow student who protested the display.

Amita