Minimally invasive surgery… pushing the frontiers further.
In an effort to reduce the trauma of access to the site of surgery, surgeons are trying out various new approaches. Laparoscopy is one of them.
In New York, surgeons removed a gallbladder through the vagina of a 66-year-old woman for the first time in the US. Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a method of performing abdominal surgery through scopes passing via the mouth, anus or vagina. I have seen videos from India of appendicectomy via the mouth and through stomach since 2004.
View in the abdomen from a transluminal endoscope, from “Transgastric surgery in the abdomen: the dawn of a new era?”, Hochberger, Juergen; Lamade´, Wolfram; GASTROINTESTINAL ENDOSCOPY Volume 62, No. 2 : 2005
In another development, a team in Carnegie Mellon University in Pittsburgh, Pennsylvania has been testing the “HeartLander”, a robot which walks on the surface of the heart to reach sites unreacheable by minimal access instruments (like “Moon Lander”, geddit?)
The plan is to insert the HeartLander through an incision below the ribcage, and pass it through a further incision in the membrane that encloses the heart. Surgeons keep track of the device using X-ray video or a magnetic tracker, and control its movements via a joystick.
There’s a video of it functioning at the Newscientist website.
Someday, open surgery will be a thing of the past. There’ll be so many other ways and means to perform various procedures with the most minimal trauma possible. I don’t think that it will be a long way away.
To undergo an op in the least traumatic and unconventional way is something to look forward to by patients but will it be more costly?
Minimally invasive surgery… pushing the frontiers further….
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just me, up-front, probably will be more costly but the hidden costs, such as time off work, might be less…
…. still needs evaluation.
I just read about this in Chen’s blog… but yours is better, got pictures wan!
mmmm… transabdominal laparascopic surgery still sounds better
Medicine seems so advanced.
May, thanks .. the pictures are from another article.
Chen, at the moment what we practise is transabdominal laparoscopic surgery. NOTES is still very much in a developmental stage…
… in the future, however, it could very well be standard. It’s an exciting new world for surgery in the future.
Capt Picard, yes.. the science of medicine is advancing, but the art of medicine is still the same
This will take years to refine
Surgery through the vagina? If that doesn’t sound invasive, I don’t know what is, LOL…. Kidding kidding
yenjai, perhaps 10 years. The way that technology moves nowadays … and the way that surgeons embrace and assimilate technology, perhaps I dare say that 10 years would not be an over-estimate for it to become mainstream surgery if its benefits are proven. Prophetic or not… time will tell.
jonzz, well … the surgeon might present a menu… thru the mouth, anus, vagina or the umbilicus. It’s an era of patient’s choice.
i guess if done at private hospitals…the cost will be high. the surgery may save him but the bill may ‘kill’ him.
nyonya, LOL…
Seriously though, actually not true… an example is laparoscopic appendicectomy (LA) compared to open appendicectomy (OA). The cost of LA is not much more than OA but the patient’s overall recovery is faster and he goes back to work earlier. So the overall cost can actually be less than OA.
Those choices that you presented to Jonzz dun sound all that exciting, especially going thru the vagina, wouldn’t that lead to scaring thus making it difficult for the woman to expand next time she wants to have a baby, just an ignorant guess here.
Dr. Bernard,
What is the difference between gastroscopy and endoscopy? Is gastroscopy done through the mouth and endoscopy through the anus or vagina? I know of a patient who had endoscopy(?) through her vagina to find out whether a stone is lodged inside her bladder after the IVP failed to show any images of any stone in her kidney.
Gosh, all the four ‘openings’ you presented sounds so GELI! Mouth, anus, umbilicus, vagina!
Patient’s choice? Hmm, my choice would be ‘no way’, LOL
FireHorse, i hear you. I don’t operate in that area, so I’d be making a guess. The report linked above mentions that Dr. Bessler, who operated, doesn’t expect the scarring doesn’t interfere with childbirth.
The vagina heals very quickly.
If it’s through the stomach or colon, scarring is not a problem. However, there’s a very important issue of contamination of the abdominal cavity with contents of the stomach and colon (which is not clean). That concern will have to be resolved first before this technique can be widely used.
Gam, gastroscopy is a subset of endoscopy. Endoscopy is any method of looking at a structure within the body using a scope.
Gastroscopy is endoscopy of the stomach. Other examples of endoscopy would be colonoscopy (colon), cystoscopy (bladder), laparoscopy (abdominal cavity), hysteroscopy (uterus), arthroscopy (joints), ventriculoscopy (brain ventricles), bronschoscopy (the airway to the lungs) etc.
I believe that the example you gave is probably cystoscopy, i.e. endoscopy into the bladder to remove the stone and NOT thru the vagina.
Jonzz, does that mean you prefer open surgery when it is required?
Thank you for the explanation. You are a great doctor. Just curious, in what cases of disease or sickness does one need bronchocopy? If I am not mistaken, the doctor told me that the wall of my husband’s lungs has thickened. He had bronchitis before.
Gam, i don’t do bronchoscopy but it’s most commonly done to investigate for suspected lung cancer, and less commonly for suspected foreign body. Also, in patients in intensive care, it’s used to clear the airways from mucus and blood clots.