French surgeons have successfully removed a woman's gall bladder through her vagina, leaving her completely scar-free, according to an expedited report published in the Archives of Surgery.
"It is exciting" to contemplate the potential of this procedure in improving patient care, write Dr Jacques Marescaux and his associatessfrom University Louis Pasteur in Strasbourg.
Over the years, 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," the authors explain. "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."
With this in mind, "natural orifice transluminal endoscopic surgery" or NOTES, was pioneered, with the "general goal of minimising the trauma of any interventional process by eliminating the incision through the abdominal wall and using natural orifices," Marescaux and colleagues report.
They used NOTES to remove the gallbladder of a 30-year-old woman. A surgeon on the team experienced in transvaginal procedures made and closed a small incision in the back of the vagina. Surgical instruments were inserted through this opening and the gallbladder was removed through the vagina.
No bleeding or leakage of liver fluids occurred during the procedure, which lasted three hours.
A quick recovery
"The patient recovered promptly after surgery, with no postoperative pain and no scars," the authors report. "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 [base of pelvis] access site."
"The road to the incision-free, pain-free, anaesthesia-free, scar-fee, risk-free cholecystectomy (gallbladder removal) is full of twists and turns," comments Dr John Hunter, at Oregon Health and Science University in Portland, in a related editorial.
"NOTES may get us closer to (the) goal of knifeless, bloodless surgery. But we are not there yet," he adds.
SOURCE: Archives of Surgery, September 2007. – (Reuters Health)
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