French surgeons took out a patient’s gallbladder without cutting her abdomen, removing it through an incision in her vagina in what they said was a glimpse of the future of surgery, they reported on Monday.
The 30-year-old, whose gallstones necessitated the removal of the pear-shaped sac near her liver, recovered quickly with little pain from what the surgeons termed a “time-consuming and difficult” operation.
A team of surgeons in New York performed a similar operation a few days before. The procedure had previously been carried out only on animals, the French surgeons said.
The goal of natural orifice transluminal endoscopic surgery (NOTES) is to avoid the trauma of cutting through the heavily muscled abdominal wall, they said.
“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,” wrote Dr. Jacques Marescaux of University Louis Pasteur, in Strasbourg, who reported on the procedure in the journal Archives of Surgery.
The surgeons cut an incision inside the woman’s vagina and utilized laparoscopic techniques employing a tiny instruments and a video camera to remove her gallbladder, a 4-inch-long (10 cm) sac that provides bile for digesting fat.
Laparoscopic surgery to remove gallbladders is common. Usually, four incisions are made in the abdomen, each 5 to 10 millimeters long, reducing recovery time and scarring. But this method poses an increased risk of damaging the bile duct, which can lead to infection.
In a critique published in the journal, John Hunter of Oregon Health & Science University in Portland wrote that the risk of bile duct injury in laparoscopic surgery was more than balanced by the benefits. But performing the operation through a single incision in the vagina made the operation that much more difficult.
Nevertheless, Hunter said the latest procedure brought the profession closer to the “goal of knifeless, bloodless surgery.”
Surgeons occasionally perform gastric surgery through a patient’s mouth, or colon surgery via the anus.
“Will NOTES generate a major paradigm shift in surgical care? We know that laparoscopic surgery is just the beginning of the minimally invasive evolution of surgery,” Marescaux wrote.
