Is Surgery Through the Vagina 'Minimally Invasive?'

"This is deja vu of 1988," Bessler said. "At a meeting a doctor presented his first laparoscopic removal, and surgeons were aghast as to how terrible this was and people asked what the benefits are."

"Now most gallbladders -- more than 90 percent -- are removed laparoscopically."

New Surgery, New Risks

But with the new technique comes new risks -- risks that Ren says are unnecessary because current options already provide relatively pain-free options with little healing time.

"When you look at what is there now -- laparoscopic gallbladder removal or laparoscopic appendectomy -- they are excellent operations," she said, adding that patients of these procedures could usually return home on the day of their surgery.

"Why make something with excellent results more complicated?"

Some other surgeons agree.

"I am not sure of the value since most patients who have laparoscopic gallbladder surgery go home the same day and have not much pain after surgery," said David Posner, chief of gastroenterology at Mercy Medical Center. "This is a technique still looking for a need."

Ren says performing an operation through the vagina opens up a new set of complications.

"You can have something called a fistula," she said. "That is a connection between the vagina and the rectum. That may not happen a lot, but you are introducing an intrinsic risk and potential complications that you do not have with standard laparoscopic gallbladder surgery."

Even those excited about natural orifice surgery say time is needed before such procedures become the norm.

"There is a clearly a need for much more data before we can establish safety," Rajapaksa said. "When we are traveling through an indirect route to get at the gallbladder, there is the potential to damage other organs along the way."

"My concern with this technique is whether there would be issues related to a scar in the vagina," Prather said. "Would this increase the risk of uterine prolapse or scarring in the area of the fallopian tubes that could increase the risk of infertility or tubal pregnancy -- an issue for female patients younger than the one in the article?"

A 'Distasteful' Operation?

Along with the risks, some regard the idea of conducting surgery through the vagina as far too odd for comfort. Even among other natural orifice surgeries, the transvaginal approach comes attached with a level of shock value that may scare away many patients.

"Everyone that has heard about this that I have talked to, they are taken aback. They say it is very distasteful," Ren said.

"A man wouldn't want to have an organ removed out of his penis. It is the same with the vagina."

Bessler, however, predicts a higher level of acceptance.

"I'm sorry that Dr. Ren feels that way," Bessler said. "I don't think women will find this repulsive -- people have vaginal surgery all the time."

"People may be shocked by this, because it is a distinctive advance and a little off the beaten path, but that is why it is interesting."

Bessler adds that other natural orifice surgeries are currently being devised that could open up the field of options to include a number of other orifices besides the vagina.

Eventually, he says, the procedures could make visible scars and long recovery a thing of the past for some surgeries.

"There are some operations today where you wouldn't consider having a six-inch incision because laparoscopic surgery is available," Bessler said. "And in 10 years they may never consider having a laparoscopic surgery when you can do it through a natural orifice."

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