April 22, 2007
Abdominal Surgery Through Orifices

No need for cutting into the abdominal wall of muscles when doing surgery.

Doctors in New York have removed a woman’s gallbladder with instruments passed through her vagina, a technique they hope will cause less pain and scarring than the usual operation, and allow a quicker recovery. The technique can eliminate the need to cut through abdominal muscles, a major source of pain after surgery.

The operation was experimental, part of a study that is being done to find out whether people will fare better if abdominal surgery is performed through natural openings in the body rather than cuts in the belly. The surgery still requires cutting, through the wall of the vagina, stomach or colon, but doctors say it should hurt less because those tissues are far less sensitive than the abdominal muscles.

A couple of the surgeons quoted in the article claim to find this approach disgusting. But anything that makes surgery less traumatic seems like a good idea for all of us. Of course half of us aren't women. But never fear. Appendix removal through the mouth anyone?

At Stanford, Dr. Myriam J. Curet, a professor of surgery, said, “It has some promise, and there’s a lot of interest in the surgical community, a lot of attention being paid to it as a wave of the future.”

Dr. Curet acknowledged that the idea was a bit disturbing at first, and said that even an audience of doctors shuddered at the video of the appendix being pulled out through the patient’s mouth.

I'm reminded of the South Park episode where the adults got it into their heads to reverse the normal direction of passage of food through the body.

In animals researchers have removed many other organs by mouth or vagina.

Dr. Bessler said he and his colleagues had been doing practice operations in the laboratory on pigs for the past year, removing gallbladders, spleens, kidneys and stomachs through the mouth or vagina.

You might hope you never have to have an organ removed either with an abdominal incision or via some orifice. But once the growth of replacement organs from stem cells becomes commonplace surgery for installation of replacement parts will become quite desirable. Got old lungs which prevent you from doing sustained aerobic activities? Put in some replacement lungs. Why not replace a few other organs in the same surgical session and recover into a more vigorous and healthy person?

Gene therapies and stem cell therapies will reduce the need for surgery. But then we'll live longer and more parts will wear out and fail. So we'll end up needing some surgery. Small insertable surgical devices will continue to reduce the size of surgical incisions. But in the longer run I'm expecting nanodevices to do a lot of surgery. Even larger yet miniature devices which aren't connected to the outside via a cable will become maneuverable as remote-controlled surgical devices. Imagine swallowing devices that pass through intestinal walls and move to an organ. Then they could transmit information out to a surgeon who'd use remote controls to direct chopping pieces out of organs and reconnecting remaining pieces.

What I wonder: Will we eventually be able to grow replacement organs within us and by doing so eliminate the need for surgery to insert replacement organs?

Share |      Randall Parker, 2007 April 22 03:49 PM  Biotech Surgery

purenoiz said at April 22, 2007 4:33 PM:

At first I wondered why not the anus for digestive organs, since it's part of the digestive tract. And then the reality of septicemia from that approach jumped into my mind. I definitely would prefer the least invasive form surgery.

ow my abs said at April 22, 2007 5:21 PM:

Slipping a new set of lungs through the vagina? o_0

BBM said at April 22, 2007 6:08 PM:

Actually we do a fair number of natural orifice surgeries (NOTES) trans-anally. Any polyp removed during a colonoscopy is technically a NOTES procedure. Also, certain polyps and early rectal cancers can be removed via transanal endoscopic microsurgery (TEMS), and at times these excisions are full thickness..

I don't think that this will take off for things like appendectomy or gallbladders because laparoscopic surgery is already pretty good from the pain standpoint. It is also more challenging and requires much more expensive equipment than standard open surgery.

The difficulty and expense of transitioning to a trans-gastric route would be huge compared to the potential payoff, and leak at the site where the stomach is opened would be a very severe complication (even if rare) compared to a problem in a small abdominal wound.

BBM said at April 22, 2007 6:12 PM:

And, of course, there are certain incisions that can be made that are small and do not cut muscle (like the bikini type incision).

Ken Hirsch said at April 22, 2007 8:41 PM:

"Slipping a new set of lungs through the vagina? o_0"

This reminds me of Steve Martin complaining that his girlfriend's vocal coach wanted her to "sing from her diaphragm!"

rsilvetz said at April 22, 2007 9:00 PM:

This is what I call, in my occasional allergy induced stupor, Extreme Medical Gaming (EMG). We engage in it because our pathetically slow medical research institutions fail to provide us with the obvious -- massive and rapid wound healing. So we take tech to irrational extremes to grab the advantages of rapid recovery time and small-wound-healing.

If you have ever seen a standard old-school gallbladder removal and the new-style, it takes five seconds to do with the big scar, and forever by the laparoscopic method. And in the old style, while I'm there, I can snip off the appendix and repair the impending hernia... And but for the scar, where all the problems are -- from esthetics to infection, what advantage is the laparascopic? There would be none if we had massive and rapid wound healing.

20 years ago we showed in animals you could do major surgery without anesthesia. We know beta-glucans halve wound healing time. We know laser irradiation during healing, start to end, will almost eliminate the scar. Some recent topical silver solutions have almost 100% infection-repelling capacity. What would happen if a few geniuses really focused on this area, looking hard at what the metalloproteases are doing and how the cell-migration/differentiation could be enhanced?

Here's hoping for the Star Trek Cell Regenerator...

Anon said at April 23, 2007 7:36 PM:

I've only ever tried to slip an organ in...

Anonymous said at December 12, 2009 8:07 PM:

Transvaginal endoscopic appendectomies was published in 2001 under the name of “Operative Culdolaparoscopy: A new Approach combining operative culdsocopy with minilaparoscopy” JAAGL. 2001; 8: 438-441

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