Incisionless Surgery with Natural Orifice Techniques

The Columbia team performed the first transvaginal gallbladder removal operation in the U.S. in March 2007. Inset: A magnified scope provides excellent imaging of the interior anatomy, allowing for precise placement of the tiny instruments.

In a first-of-its-kind operation in the U.S., surgeons and a medical interventional endoscopist at NewYork-Presbyterian Hospital/Columbia University Medical Center have removed a woman's gallbladder with flexible instruments passed through her vagina. This experimental procedure was part of a study being done to determine whether people will have less pain and scarring, and faster recovery, if abdominal surgery is performed through a natural orifice rather than through incisions in the belly.

Natural Orifice Translumenal Endoscopic Surgery, or NOTES, is a new method of performing minimally invasive surgery through the mouth, anus, or vagina. Although a small internal incision must be made in the vaginal wall to access the gallbladder or other internal organ, such incisions should hurt less than traditional abdominal incisions because those tissues are less sensitive to pain than abdominal muscles.

Although laparoscopic surgery has afforded patients tremendous benefits in reducing trauma and shortening recovery, there is still significant room for improvement, says Marc Bessler, MD, Director of Laparoscopic Surgery. Dr. Bessler performed this surgery with colleagues Peter Stevens, MD, Director of Endoscopy at NewYork-Presbyterian Hospital/Columbia University Medical Center, and Dennis Fowler, MD, Director of the Minimal Access Surgery Center, who have been at the forefront of research to make surgery even less invasive. In this procedure, the team made just three tiny laparoscopic incisions in the patient's abdominal wall, in contrast to the four substantially larger incisions usually required during a traditional laparoscopic cholecystectomy. "The patient felt almost no pain upon recovery, other than some minor discomfort at one laparoscopic site. We believe this approach will provide patients the benefit of reduced pain, faster recovery time and fewer scars than the traditional laparoscopic alternative," said Dr. Stevens. "As we enroll additional patients and gain experience with this technique, we expect to reduce the number of laparoscopic ports—with the goal of a true incisionless procedure," said Dr. Bessler.

In addition to transvaginal removal of the gallbladder, the Columbia team is conducting minimally invasive procedures for appendectomy, gastroesophageal reflux, and weight loss surgery.

To learn more, call 855-CUSURGE.

Add comment