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Removing organs through the rectum?
Gallbladder through vagina opens possibilities
In the future, minimally invasive surgery may be performed though the rectum, with an incision made in the large intestine, according to surgeons at New York–Presbyterian Hospital and Columbia University Medical Center who recently removed a woman's gall bladder through her vagina.
As part of a clinical trial, surgeons used a technique called natural orifice translumental endoscopic surgery (NOTES) to insert an endoscope through the patient's vaginal wall and into her body cavity. NOTES has been used at the hospitals for appendectomy, abdominal exploration, and biopsy. This surgery went a step further: into the patient's abdominal cavity.
The gallbladder was removed through the vagina, which then was sutured. "Internal incisions, such as in the vaginal wall, are less painful and may allow for quicker recovery than incisions in the abdominal wall," says Marc Bessler, MD, FACS, who led the surgery. Bessler is director of laparoscopic surgery and director of the Center for Obesity Surgery at New York — Presbyterian and Columbia and assistant professor of surgery at Columbia University College of Physicians and Surgeons, all in New York City.
This technique allows surgeons to make smaller and fewer skin incisions, Bessler says. Furthermore, doctors in France have announced they removed gall bladders through the vagina without any abdominal incisions, according to an April 29 story from The Associated Press (AP). The surgical staff pierced the patient's abdomen with a needle about one-tenth of an inch wide, the AP reports. The needle, which included a video camera system, was used to inflate the abdomen, the story said. Doctors in India say they have performed appendectomies through the mouth, according to the AP. (Editor's note: For more information, go to www.noscar.org.) Sources say avoiding cuts through a patient's abdominal wall avoids cutting a large number of nerves, which take time to heal, and may reduce recovery time.