Doctors in New York have removed a woman's gallbladder with instruments passed through her vagina, a technique they hope will cause less pain and scarring than the usual operation, and allow a quicker recovery. The technique can eliminate the need to cut through abdominal muscles, a major source of pain after surgery.
The operation was experimental, part of a study that is being done to find out whether people will fare better if abdominal surgery is performed through natural openings in the body rather than cuts in the belly. The surgery still requires cutting, through the wall of the vagina, stomach, or colon, but doctors say it should hurt less because those tissues are far less sensitive than the abdominal muscles.
Interest in this idea heightened after doctors from India made a video in 2004 showing an appendix being taken out through a patient's mouth. The patient had abdominal scars that would have made conventional surgery difficult.
The New York patient, 66, had her gallbladder removed on March 21 and is recovering well, said her surgeon, Dr. Marc Bessler, the director of laparoscopic surgery at Columbia University Medical Center. Bessler said he thought it was the first time the operation had been performed in the United States, and he plans to show a video of the operation at a gastroenterology meeting in Las Vegas on Sunday.
"Going through a natural orifice, the mouth or rectum or vagina, to get into the abdomen and do an operation, is being excitedly worked on by a whole lot of people," Bessler said, adding that companies were beginning to make special surgical tools for the operations and that doctors had formed an organization called NOSCAR (www.Noscar.org), which stands for Natural Orifice Surgery Consortium for Assessment and Research.
The idea is part of a broader trend to make surgery less and less invasive. In the late 1980s and early '90s, surgeons began removing gallbladders with laparoscopic surgery, performed through a few small slits in the belly for a camera and surgical tools instead of the 10-inch incision needed for the original, open operation. Although some doctors were skeptical at first about the laparoscopic approach, it soon caught on, and now accounts for 90 percent of gallbladder operations.
"But patients still have pain, recovery time, and scars," Bessler said. "The next phase to make it better is to eliminate the remaining causes of pain — incisions and instruments that have to go through the muscles of the abdominal wall."
Surgeons not involved in the research had mixed reactions.
Dr. Christine Ren, an associate professor of surgery at New York University's school of medicine, called the vaginal procedure "repulsive" and said: "As a woman I find it very invasive, physically and emotionally. To me it's quite distasteful. You will really have to prove to me that there is a benefit."