Natural Orifice Surgery: No Scars
Surgery Without External Cuts Called 'Next Greatest Surgical Evolution'
Sept. 17, 2007 - French doctors who report removing a woman's gallbladder
through her vagina say such "no-scar surgery" may be the wave of the
At least two U.S. women -- one at New York Presbyterian Hospital and another
at the University of California San Diego Medical Center -- have undergone
Doctors who advocate the technique call it "natural orifice transluminal
endoscopic surgery" or NOTES. "Natural orifice" here means the
vagina, the anus, or the mouth. "Transluminal" means surgeons insert
surgical tools (endoscopic tools) through the body's natural openings. And the
"surgery" part means doctors still have to cut through to the inside of
the body and to operate on diseased organs.
The idea is to eliminate big incisions -- and surgical scars -- and to speed
recovery after surgery.
Jacques Marescaux, MD, and colleagues at Louis Pasteur University in
Strasbourg, France, appear to have been the first to perform NOTES surgery
without backup from the laparoscopic instruments used for conventional
minimally invasive surgery.
"With its invisible mending and tremendous potential for improving
patient care and well-being, NOTES might represent the next greatest surgical
evolution," Marescaux and colleagues suggest.
The surgeons report details of the operation in the September issue of
Archives of Surgery.
Fast Recovery After Natural Orifice Surgery
Marescaux and colleagues performed the NOTES gallbladder removal on a
30-year-old woman with gallstones. The surgeons used endoscopic tools inserted
through the woman's vagina during general anesthesia.
To reach the gallbladder, the surgeons made a small incision at the rear of
the woman's vagina. The only external incision was a tiny cut in the woman's
abdomen to insert a needle scope (the cut was also used to inflate the
abdominal cavity with gas and to aid in removal of the gallbladder). The
gallbladder was removed through the vagina.
On the evening after surgery, the woman felt well enough to go home. Because
she was their first NOTES patient, her doctors kept her overnight and she left
the hospital the next morning. Ten days later, the woman had resumed full
activity with no discomfort, discharge, or bleeding.
Doctors developing the NOTES technique say similar operations could be done
by mouth. However, this would mean making a cut in the stomach or gut to get to
internal organs. Research continues on the best way to make sure these cuts can
be closed without risk of leakage.
A group of surgeons has formed the Natural Orifice Surgery Consortium for
Assessment and Research -- NOSCAR -- to promote NOTES research and responsible
use of the technique. The group hopes to develop better techniques and better
medical tools for NOTES surgeries.
NOTES vs. Laparoscopy
The NOSCAR group obviously is promoting the "no scar" aspect of
NOTES. But current minimally invasive laparoscopic surgical techniques already
leave no lasting scar, says John G. Hunter, MD, professor and chairman of
surgery at Oregon Health & Science University in Portland.