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.

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.

An eighty-year-old man came with abdominal pain and vomiting for a week. Examination shows a dehydrated patient with abdominal distension and tenderness; it was most painful at the right upper quarter of the abdomen.

An abdominal X-ray taken supine (lying down) looks like this:

So what’s going on here? This:

It’s completely normal to have gas in the intestines. But gas should not be in the abdominal cavity outside of the intestines. It means that somewhere along the stomach or intestines, gas has leaked out.

Now, that’s dangerous. The gas is not dangerous… it’s the other material that leak with the gas that’s dangerous. It means that the contents of the stomach or intestines have leaked out to the abdominal cavity. These are full of bacteria, stomach acid, bile and enzymes. They can kill.

This means that the patient needs urgent surgery to identify the leak and repair it. This was found to be a leaking stomach ulcer. It was repaired and the leaking material was washed out. The gallbladder and the stone inside it were removed as well.

I’ve mentioned anal fissures before on this blog. These are breaks in the anal skin caused by passage of hard stools. They are also caused by tight anal sphicters (anus control muscles). The tight sphincter causes blood supply to the skin breaks to be reduced and this prevents proper healing of the anal skin. It’s a vicious cycle of tight sphincter… anal fissure…. pain…. tighter sphincter… more anal fissure… more pain…..

Are fissures dangerous? Well, they cause a lot of pain. They sometimes bleed, but it’s never a lot. I’m going to break the rule of “never say never or always” and say that it always stops by it self and is more scary than dangerous. The problem is in differentiating a simple fissure from other more dangerous causes.

Having said that… don’t you think that the potential pain is bad enough to motivate poeple to prevent it?

Now, this is an acute fissure.. one which had been there for a short while only. This is caused by the passage of hard motion. It should heal if pain is controlled and the motion is softened.

This is a colonoscopy picture. It was not done to diagnose fissures… the diagnosis can be made by examination alone.

So keep your motion soft. Take enough fibre and practice good toilet habits. I can never say this too much.

Colonoscopy is the examination of the whole length colon from the junction between the small and large intestines down to the anus. Besides the pretty sight of the waving villi in the end of the small intestines that greet the endoscopist at the completion of colonoscopy, there another structure that the endoscopist looks for….

The appendix is attached to the beginning of the colon (called the caecum) and when you look at it from the inside of the colon, the base is all you see. As the picture above.

Just to give you a view of the appendix from outside the colon…