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Medical Advances and Breakthroughs

Scar-Free Surgery

Linda Qua's first gallbladder attack, two years ago, was so painful, she thought it might be her heart. The culprit was a marble-size gallstone pressing against her stomach and intestine. Some 20 million Americans — more women than men — experience gallstones, when substances in the gland harden into stone-like material.

Qua, 48, an assistant preschool teacher in San Diego with two teenage boys, was offered a choice for having her troublemaking gallbladder removed. The first option: laparoscopic surgery, in which doctors would make four small incisions in her abdomen to view the abdominal cavity, pass instruments back and forth, and remove the diseased organ. Option two, though strange, was more intriguing: Doctors would remove the gallbladder through a natural opening in Qua's body.

Called natural orifice translumenal endoscopic surgery (NOTES), such operations include removing gallbladders and appendixes and repairing hernias through the patient's mouth or vagina. There's only a small puncture in the belly button, where the surgeon inserts a minicamera and a light to help guide the procedure.

Several centers around the country, including the UC San Diego Medical Center, New York-Presbyterian Hospital in New York City, and Northwestern Memorial Hospital in Chicago, are performing the surgeries now, and more are expected to start as companies develop the specialized instruments the procedures require.

Unlike standard abdominal operations, NOTES avoids cutting through abdominal muscles. External incisions not only are painful, but also can take weeks to fully heal and can cause complications like hernias. The small internal cuts that NOTES surgeons make, generally in less sensitive internal organs like the stomach or vagina, heal quickly and are not exposed to germs. "An open wound can cause an infection," says Qua's surgeon, Santiago Horgan, M.D., chief of minimally invasive surgery at UC San Diego Medical Center. "With the tiny puncture hidden deep in the belly button, we minimize that risk while achieving a scarless cosmetic result."

At first, Qua wasn't thrilled at the idea of having her gallbladder removed through her vagina. But having had major scoliosis surgery in her teens, she knew what being cut open and having stitches meant. "I wanted to avoid that pain and long recovery," she explains.

Her decision was the right one. "My sister had her appendix removed through traditional abdominal surgery and was wiped out and in bed for two weeks," Qua says. "I needed a painkiller for just two or three days. A week later, I was back to my regular activities, even chasing the kids at school, with only a little tenderness around my belly button."

Mood-Lifting Implants

Some 18 million Americans suffer from major depression. Of them, about one in five never gets better, no matter what therapy is tried.

Leslie Schaefer, 55, fell into that so-called treatment-resistant group. Her problems began when she was about 20, newly married, and starting a family in Rockport, MA. She worked at a bank and enjoyed teaching Sunday school.

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