Gallbladder removed through mouth in new surgical technique

As part of the trend in developing surgeries without external wounds, surgeons last week removed a woman's gallbladder through her mouth. The operation was performed as part of a clinical trial at UC San Diego School of Medicine.

The surgery is called NOTES -- which stands for natural orifice translumenal endoscopic surgery. The idea is to use the mouth or vagina as routes to parts of the body requiring surgery. In traditional laparoscopic -- or minimally invasive -- surgery, doctors make several small incisions through the abdominal wall and insert a tiny camera and tools to remove the gallbladder or appendix. That type of surgery is a big improvement upon the long, open incisions that patients used to require.

However, NOTES spares patients even the tiny abdominal incisions. Tools are passed down the mouth and through a hole created in the stomach. In the recent surgery, lead investigator Santiago Horgan made two tiny incisions (not requiring stitches) to pass a camera into the abdomen to increase visibility. However, the gallbladder was removed by way of the mouth.

The procedure was done as part of a study that will evaluate the safety and efficacy of NOTES compared with  laparoscopy as well as the pain levels, cosmetic outcome, costs and other outcomes, Horgan said in a news release. Horgan is the director of UCSD's Center for the Future of Surgery. The hope is that natural orifice procedures will reduce the risk of infection and pain as well as abdominal scars. The center also performed the first oral appendix removal.

-- Shari Roan

Comments

[betsy]

Say Ahhhhhhh!

[the truth]

heck, i did that to some dude who insulted my girlfriend years ago.

[dee]

So just how do they get from the mouth to the gallbaldder, or from the vagina to an abdominal organ, without an internal 'incision' of some kind? These are not just pouches with openings to the 'organ world' at either end. The author suggests that having no external wound--even a very small one, or going through the umbilicus to the abdomen--is what is damaging. After forty years in medicine, I'd take a more direct route with less chance of perforating related internal organs than going through the mouth/vagina. Of course, this article is just a cursory one--more detailed information would certainly be helpful. Diagrams?

[NorthernCA Teacher]

I had my gall bladder removed via my belly button and there was not pain afterwards. Now 20 years later, there is only a very tiny scare on the abdominal wall where one of the tools was inserted.

Since many women with "bad" gall bladders are obese, maybe they should throw in the option of performing stomach-size-reduction at the same time.

I tried to have them take out my appendix at the time, but they said it was not "close-bye."

[juan]

To think that a gastrotomy (opening of the stomach) is less dangerous that a small abdominal wound in terms of infection risk is prepousterous. No everything that can be done should be done. This is not a procedure for the "future of surgery". I hope the patients that agree to participate in this study receive full disclosure of risks.
A very dangerous study for sure.