Is Surgery Through the Vagina 'Minimally Invasive?'

In a first-of-its-kind procedure last month, a team of surgeons successfully removed a woman's gallbladder using instruments passed through her vagina.

Marc Bessler, director of laparoscopic surgery at New York Presbyterian Hospital-Columbia University Medical Center, presented a video of the experimental surgery Sunday at a gastroenterology meeting in Las Vegas.

The first surgery was performed on a 66-year-old patient. Nine days later, a similar procedure was conducted in France, leading Bessler and others to say that such "natural orifice" procedures could well define the future of surgery.

The idea, he says, is to offer patients operations with less pain and fewer visible scars.

And the notion makes sense. Such procedures would allow surgeons to avoid cutting through a patient's abdominal wall, which contains a bounty of nerves and takes time to heal.

"The advances are decreased scars -- and eventually no scars -- decreased pain and quicker recovery," Bessler said.

But critics say the idea of conducting surgery through the vagina is simply too revolting to gain wide appeal.

"To put something like that through the vagina -- I just think it is crude, and there aren't many things that should be going in and out of the vagina," said Christine Ren, assistant professor at New York University's school of medicine. "I don't think a gallbladder should be, or those instruments."

More importantly, Ren notes, the technique comes attached with new considerations that could put women at an increased health risk during procedures now considered low risk and routine.

The New Minimally Invasive

Bessler says the transvaginal surgery is just one of a new host of procedures surgeons are developing that are conducted through natural openings such as the mouth or rectum instead of through the skin.

Some gastroenterologists say this tactic could well define surgery in the years and decades to come.

"I think this novel approach does represent the wave of the future," said Roshini Rajapaksa, assistant professor of medicine at the NYU school of medicine's division of gastroenterology.

"Patients are more interested than ever on less invasive surgeries, and doctors agree when they can be performed safely with less scarring and quicker recovery time," he said

Aside from the extra pain and healing time needed after skin incisions, many patients are likely to be intrigued by the avoidance of skin scarring.

"Natural orifice surgery is a developing surgical technique that is very exciting. Most patients would prefer not to have abdominal scars," said Charlene Prather, associate professor of internal medicine at Saint Louis University's Division of Gastroenterology and Hepatology.

This is not the first time that surgeons have used natural orifices as entry points for surgery. In 2004, a video that showed doctors from India conducting appendix surgery through a patient's stomach -- and removing the organ from his body through his mouth -- piqued the interest of surgeons around the world.

In recent months, doctors at other medical centers have worked toward developing instruments and procedures for such operations. Some surgeons are already comparing the current advances in natural orifice surgery to those seen with laparoscopic surgery, in which tiny instruments are used to perform abdominal operations through small incisions, nearly two decades ago.

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