Procedure leaves no scars and reduces pain, but not all doctors endorse it
MONDAY, Sept. 17 (HealthDay News) -- French surgeons report removing a gallbladder through a woman's vagina, joining a handful of surgeons around the world who are trying the novel technique, because it eliminates visible scarring and minimizes postoperative pain.
In March, surgeons at Columbia University in New York City performed a similar operation, and, last week, so did surgeons at the University of California, San Diego. The procedure has also been used for removing the appendix.
"Not many of these procedures have been done yet," said Dr. Kurt E. Roberts, an assistant professor of gastroenterology at Yale University School of Medicine's department of surgery. "Since so few have been done, the potential complications aren't known."
Roberts expects more of these surgeries in the future because of the advantages. "The procedure leaves no scars and also reduces pain," he said.
But not all surgeons find this new procedure appealing.
"As a woman, I find it distasteful and invasive to have the vagina used as a midtown tunnel for the traffic of surgery, simply because there are a few surgeons who are looking to find something new to do," said Dr. Christine Ren, an assistant professor of surgery at New York University School of Medicine.
In the French report, Dr. Jacques Marescaux and colleagues at University Louis Pasteur, Strasbourg, removed the gallbladder from a 30-year-old woman. During the operation, surgeons made a small incision in the back of the vagina. Then, using specially designed instruments inserted through this opening, they removed the gallbladder through the vagina.
There was no bleeding or leakage of liver fluids during the three-hour procedure, according to the report in the September issue of the Archives of Surgery.
"The patient recovered promptly after surgery, with no postoperative pain and no scars," the authors wrote. Although the woman could have left the hospital the same day, the doctors kept her hospitalized two days after the operation, because this was their first such surgery.
When the doctors saw the woman 10 days later, she was back to normal and had no bleeding, discharge or discomfort, according to the report.
"It is exciting to contemplate the potential for natural orifice transluminal endoscopic surgery in improving patient care," the researchers wrote. "A surgical intervention that eradicates the need for any incision, avoiding bodily trauma, is attractive to patients and also has an aura that surgeons find hard to resist."
But Ren thinks the basic premise of this type of surgery -- called natural orifice transluminal endoscopic surgery -- is misguided. "I admire the surgeons for their innovation and forward-thinking. However, the basic philosophy is backwards," she said.
One of the basic principles of surgery is to avoid injury to internal organs, because, even if they are repaired, there still is an inherent risk of the repair tearing apart, Ren said. "If this happens, serious infection can occur which occasionally is fatal. In this paper, the vaginal wall is purposely injured and therefore opens the possibility for more serious complications," she said.
The standard way of removing a gallbladder -- laparoscopically -- is safer than doing it through an open cut, Ren said. The advantage that natural orifice transluminal endoscopic surgery provides -- which the French researchers call "scarless" and "less painful" -- is negligible when compared to the scars and pain that patients experience after non-laparoscopically performed surgeries, she said.
In addition, the operation through the vagina takes three to four times longer than it takes to perform laparoscopically, increasing the risk to patients who need more anesthesia, Ren noted.
Roberts is concerned that doctors may try to perform the procedure without the proper training.
"Until the procedure becomes common, it should be restricted to academic settings and to trained surgeons," he said. "It takes doing a number of procedures before surgeons become proficient."
For more on gallbladder surgery, visit the U.S. National Library of Medicine.
SOURCES: Kurt E. Roberts, M.D., assistant professor of gastroenterology, Department of Surgery, Yale University School of Medicine, New Haven, Conn.; Christine Ren, M.D., assistant professor of surgery, New York University School of Medicine, New York City; September 2007, Archives of Surgery
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