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New Technique Removes Gallbladder Without External Incisions

Endoscope was inserted through 1-inch cut behind uterus and into woman's body cavity

FRIDAY, Aug. 8 (HealthDay News) -- In what they say may be the first operation of its kind in the United States, surgeons at New York-Presbyterian Hospital/Columbia University Medical Center removed a woman's gallbladder without making any external incisions.

The procedure, offered as part of an ongoing clinical research trial, involved insertion of an endoscope through a one-inch incision behind the uterus and into the woman's body cavity. Using the scope, surgeons detached the gallbladder and removed it through the incision behind the uterus.

Natural Orifice Transluminal Endoscopic Surgery (NOTES) could prove to have a number of advantages over traditional endoscopic surgery, including less pain, quicker recovery, and absence of visible scarring, the surgeons said.

"This procedure marks the culmination of 15 years of advances that have made surgery less invasive in order to improve safety and reduce recovery time," Dr. Marc Bessler, director of laparoscopic surgery and director of the Center for Obesity Surgery at NYPHospital/CU, said in a hospital news release.

In April 2007, the same team made headlines after they removed a woman's gallbladder through her uterus, using flexible endoscopy and several external incisions for added visibility.

The NOTES procedure takes that a step further by eliminating all external incisions.

"Internal incisions, such as in the uterus, are less painful and may allow for quicker recovery than incisions in the abdominal wall," said Bessler, who is also professor of surgery at Columbia University College of Physicians and Surgeons.

In addition to gallbladder surgery, the clinical trial offers NOTES for appendix removal and abdominal exploration and biopsy. Currently, the procedure is only available through the uterus. In the future, it may be possible to perform the procedure through the mouth or rectum, making it available to men.

NOTES was developed at Johns Hopkins, and it's believed the first NOTES procedures were performed by surgeons in Brazil and India.

More information

The MedlinePlus Medical Encyclopedia has more about endoscopy.

-- Robert Preidt

SOURCE: New York-Presbyterian Hospital/Columbia University Medical Center, news release, July 28, 2008

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