A woman in France had her gall bladder successfully removed via her vagina – no outer incisions were made – according to an article published in Archives of Surgery (JAMA/Archives).
The authors explain that surgery has moved toward less invasive procedures. “Whenever it was possible, patients would ask for a surgical procedure that left no outer scarring and resulted in no postoperative pain. Patients, both male and female, independent of age and body shape, dislike scars, not only for cosmetic reasons but because scars indicate they have undergone treatment because of illness. This resulted in natural orifice transluminal endoscopic surgery (NOTES), with its general goal of minimizing the trauma of any interventional process by eliminating the incision through the abdominal wall and using natural orifices,” the authors write.
Jacques Marescaux, M.D., F.R.C.S., University Louis Pasteur, Strasbourg, France, and team carried out a gall bladder removal (cholecystectomy) through the vagina of a 30-year-old female patient. The surgical team included a gynecologist experienced in transvaginal procedures – he made the small incision at the back of the vagina, and later closed it up. Instruments were inserted through this vaginal opening and the gall bladder removed, say the authors. The surgical team said that during the three-hour procedure there was no leakage of liver fluids or bleeding.
The authors explain “The patient recovered promptly after surgery, with no postoperative pain and no scars. Although she was feeling well on the evening of the surgery, we elected to discharge her on postoperative day two because this was our first case. At the follow-up visit 10 days after surgery, the patient had completely resumed full activity, with no discharge or bleeding and no discomfort at the perineal [bottom of pelvis] access site. It is exciting to contemplate the potential for NOTES in improving patient care. A surgical intervention that eradicates the need for any incision, avoiding bodily trauma, is attractive to patients and also has an aura that surgeons find hard to resist.”
The authors added that these benefits must be proven with good research and be demonstrated as at least comparable to accepted surgical criteria – also, surgeons must be properly trained in the new procedures.
Arch Surg. 2007;142(9):823-827
Written by: Christian Nordqvist