Medicine Surgery

A transvaginal gall bladder operation?

When I saw this, I thought it had to be a joke. But it’s not:

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.

Interest in this idea heightened after doctors from India made a video in 2004 showing an appendix being taken out through a patient’s mouth. The patient had abdominal scars that would have made conventional surgery difficult.

The New York patient, 66, had her gallbladder removed on March 21 and is recovering well, said her surgeon, Dr. Marc Bessler, the director of laparoscopic surgery at NewYork-Presbyterian/Columbia University Medical Center. Dr. Bessler said he thought it was the first time the operation had been performed in the United States, and he plans to show a video of the operation at a gastroenterology meeting in Las Vegas on Sunday.

“Going through a natural orifice, the mouth or rectum or vagina, to get into the abdomen and do an operation, is being excitedly worked on by a whole lot of people,” Dr. Bessler said, adding that companies were beginning to make special surgical tools for the operations and that doctors had formed an organization called Noscar (, which stands for Natural Orifice Surgery Consortium for Assessment and Research.

I basically agree with Sid Schwab on this one:

One has to wonder what is the motivation. According to those that advocate such things as pulling an appendix out a person’s mouth or anus, the aim is to reduce pain and scarring for patients. I call bullshit. I think the motivation is “Hey, look at me!”

See, we’re already at a point where most operations done laparoscopically require holes around a quarter inch in size, with maybe one more, closer to an inch. Cosmetically, not a major problem. Pain-wise, pretty minimal, most of the time. So we’re talking, according to the rationale, about lessening something already pretty minimal. Moreover, since it’s literally impossible completely to sterilize the mouth, rectum, or vagina, any procedure done through them will necessarily introduce organisms into the abdominal cavity. A small number may not always be significant. Still, it’s of concern. And the hole that’s made needs to be sealed back up safely, especially one in the stomach or colon. Finally there’s this: these procedures take longer and afford a less-good view of the target area, unless at least one or two holes are made in the abdomen anyway.

Surgeons have egos (surprise! surprise!), and these egos sometimes lead them to a sort of “can you top this?” competition to see who can be the most studly. Clearly the transvaginal cholecystectomy is an example of just that, and, after these surgeons show the videotape of the operation at a surgical meeting as planned, you can expect a lot of other surgeons wanting to try this operation. I guess guys are out of luck. If we want a “no scar” gallbladder operation, we’ll have to let surgeons make holes in our stomachs to pass the endoscope through, with the chance of leakage of stomach acid into the abdominal cavity if there are problems healing the hole in the stomach. Going through the rectum, given the level of contamination there, would probably not be such a good idea, although I’m sure someone will try it.

This competition is not necessarily all bad, as it led to the rapid proliferation of laparoscopic surgery, allowing the performance of complex operations through ever smaller incisions, with the attendant decrease in pain and hospital stay, although the curmudgeon in me can’t help but point out that laparoscopic colon resections, for instance, produce only a marginal decrease in the time it takes for bowel function to return (less than a day less, in fact, than conventional open surgery). In any case, this report seems to little more than the case of surgeons, like birds, showing their plumage to other surgeons to warn them that they’re the studliest surgeons of all.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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