No muss, no fuss, no bother: gall bladder removed through the vagina. After making progress in maximally invasive surgery, we now have arrived at a day where surgery is painless and blood-less. Removing or performing surgery on internal organs through natural pathways is new, but hardly a trend. True, the surgery leaves no scar and no post-op surgical pain. However, in so doing, the vagina has been surgically cut. It may not repair well, leaving painful internal scar tissue in the future. It may even rip open, or perforate. When an organ perforates, it usually leads to serious complications, including death. Additionally, the body is now open for another area of infection.
This type of surgery also takes longer, than a laparscopy; therefore, the patient must cope with the anesthesia assault longer. Anesthesia has an entire arsenal of potent medications which are used during an operation; so the longer your body is absorbing these drugs, the more potential for harm. Furthermore, if an artery is accidentally ‘knicked’, as sometimes occurs in invasive surgery, managing the bleeding will become difficult if not impossible, as there will be little room for maneuvering or easy visualization.
Laparoscopy is a type of surgical procedure in which a small incision is made, usually in the navel, through which a viewing tube (laparoscope) is inserted. The viewing tube has a small camera on the eyepiece. This allows the doctor to examine the abdominal and pelvic organs on a video monitor connected to the tube. Other small incisions can be made to insert instruments to perform procedures. Laparoscopy can be done to diagnose conditions or to perform certain types of operations. It is less invasive than regular open abdominal surgery.
Performing surgeries via laparscopy was heralded as one of the major advances in surgery of the 20th century. From the time of the first laparscopy to within 4 years, almost all abdominal surgeries were converted to this less invasive form of surgery. Laparscopy surgery is less painful post-op, and recovery time is shortened. This type of surgery has allowed for the greater majority of surgeries being performed in an outpatient surgical center.
The advance of surgery using natural openings has been vastly different. Natural orifice transluminal endoscopic surgery (NOTES) uses natural openings in one’s body to avoid an abdominal incision. NOTES has been performed periodically over the past few decades. Openings which are considered for entry are the vagina, urethra (i.e. tube you urinate from), rectum, and mouth/oral cavity. The settings for these surgeries have been a few academic type setting. Those who have performed such surgeries, feel it is the paradigm surgical shift of the next several generations. However, some surgeons find the image distasteful, such as using the vaginal canal as a traffic conduit to obtain access to other organs. Other surgeons feel that it is too soon to see the long term consequences of such surgery. They also indicate that the amount of additional training which would be required to perform such surgery would lengthen residency programs significantly. Finally, they strongly feel that until the procedure becomes common, it should be restricted to academic settings only.
Sources
Surgeons Remove Gallbladder Through Vagina: Procedure leaves no scars and reduces pain, but not all doctors endorse it, Health Day, October 17, 2007
http://www.nlm.nih.gov/medlineplus/news/fullstory_54919.html
Marescaux, J. et al,: Surgery Without Scars, Archives of Surgery, September, 2007
http://archsurg.ama-assn.org/cgi/content/abstract/142/9/823
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