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    Medical Advances and Breakthroughs

    Knee Self-Repair continued...

    Although not every patient is so lucky, among a group of 50 people slated for knee replacement in Dr. Centeno's pilot study, almost 90 percent had at least a 50 percent improvement in function and pain. And for half of these volunteers, the improvement was 75 percent. Next up: a randomized, controlled study.

    Today, Greenemeier can work — and work out — without pain. She's enjoying all her favorite fitness activities, including deep squats at her conditioning classes. "I can go all the way down again," she reports. And her 12-hour shifts at the hospital are not a problem. "The other day, I finished and my knee was a little sore," she says. "Then I realized it was my left knee — not the injured one."

    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."

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