The old-fashioned method of gallbladder surgery can make for a very painful experience. But surgeons at Northwestern Memorial Hospital performed a painless gallbladder removal by removing the gallbladder through the patient’s mouth. This is a very rare procedure known as “laparoscopic assisted natural orifice translumenal endoscopic surgery” or NOTES for short. The procedure is being referred as groundbreaking and leading the way to other incision-less procedures.
It has the potential to lessen the amount of pain and other side effects of the traditional surgery and it may also lessen the recovery time to as little as one day.
There are many reasons why surgeons are showing so much interest in this type of procedure. First of all, the stomach and the GI tract do not have that many nerves and that means they do not register that much pain. Someday this fact may enable the surgeon to perform a NOTES operation just using sedation instead of general anesthesia. Another plus side to NOTES is there will be no post operative wound to become infected, or to develop a hernia.
It will speed recovery, would greatly reduce costs and the amount of pain.
Even thought the operation itself is very new, the idea has been floating around the medical community for years. Up until now the surgery was impossible because the endoscopic devices that are currently available do not have a platform for it. By using a stable operation platform, the surgeon can move the instruments around to allow him to view, then cut, then grab and then suture tissue without making any incisions in the skin. Imagine surgery with no scars and very little pain.
There are risks with this as there is with any surgical procedure. The main one is being able to properly suture the incision that is made in the stomach. If it is not closed properly, there could be complications.
They do need some very special equipment and the ones that they used are the EndoSurgical Operating System by USGI Medical and additional endoscopic equipment made by Olympus.
In this operation they used three small laparoscopic ports. Ports are the points through which they insert the laparascope – a thin, lighted tube used to look inside the abdomen. They used three to order to really be able to get a good assessment of the safety factors of the operation and to also be able to refine the technique. As they do more operations and they have all the details and everything worked out, they expect to be able to gradually stop using the ports alltogether.
For this case, three small laparoscopic ports were used in conjunction with the endoscopic system in order to assess the safety of the procedure and to assist in refining the technique. Current risks include proper suturing of the incision that is created in the stomach, as if not closed properly, complications could occur. The team expects to gradually eliminate these external ports in future procedures.
The surgery was performed by Nathaniel Soper, MD, who was the surgeon in charge, Eric Hungness, MD another surgeon and John Martin, MD, a gastroenterologist.
Dr. Soper, who is also the Loyal and Edith Professor and Chair of Surgery at Northwestern University’s Feinberg School of Medicine.
Source: Northwestern Memorial Hospital http://www.nmh.org/
