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Surgeons remove gallbladder without outer incisions
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CHICAGO—French surgeons successfully removed a woman’s gall bladder through her vagina, according to a report in the September issue of Archives of Surgery, one of the JAMA/Archives journals.

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The history of surgery has moved toward less invasive procedures, according to background information in the article. "Whenever it was possible, patients would ask for a surgical procedure that left no outer scarring and resulted in no postoperative pain," the authors write. "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."

Jacques Marescaux, M.D., F.R.C.S., and colleagues at University Louis Pasteur, Strasbourg, France, performed a cholecystectomy (gall bladder removal) through the vagina in a 30-year-old woman. The surgical eam was multidisciplinary and included a gynecologist experienced in transvaginal procedures, who made and closed the small incision in the back of the vagina. The procedure was performed with instruments inserted through this opening and the gallbladder was removed through the vagina. No bleeding or leakage of liver fluids occurred during the three-hour procedure.

"The patient recovered promptly after surgery, with no postoperative pain and no scars," the authors write. "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," they continue. "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." However, these benefits must be supported by research and show results comparable to the currently accepted surgical criteria, and surgeons must be trained properly in the new procedures, they note.
(Arch Surg. 2007;142(9):823-827.

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