Home E-Weekly July 2, 2007

A New Frontier for Gall Bladder Removal?

Published: October 10, 2007

In a step forward for the experimental and controversial practice of natural orifice surgery, surgeons at the Oregon Clinic in Portland have successfully completed the first-in-the-U.S. transgastric endoscopic cholecystectomies, in which three patients' gall bladders were removed via their mouths.

According to the clinic, Lee Swanstrom, MD, and his surgical team inserted flexible instruments through the patients' mouths and throats, made incisions in their stomachs, laparoscopically removed their gall bladders and closed the incisions. None of the patients suffered any complications and all reported rapid recoveries, says the clinic.

"These initial cholecystectomy procedures are an important first step in the development of methods and devices to enable the widespread adoption of incisionless natural orifice transluminal endoscopic surgery," says Dr. Swanstrom, director of the clinic's division of gastrointestinal and minimally invasive surgery and a founding member of the Natural Orifice Surgery Consortium for Assessment and Research, or NOSCAR.

"In our first patients, we used two or three small laparoscopic ports to assess the safety of the procedure and to assist in the refinement of the technique. As we continue to gain experience, our protocol allows us to begin to eliminate these external ports," he says.

The advance follows on the heels of other natural orifice procedures, including the surgical removal of a woman's gall bladder through her vagina, a video of which was presented at the SAGES conference this spring.

"Operating through the body's natural orifices offers promise for faster healing times, less scarring and less pain, which could lead to reduced hospitalization and quicker recovery," says David W. Rattner, MD, co-chair of NOSCAR's ASGE/SAGES joint committee and chief of general and gastrointestinal surgery at Massachusetts General Hospital in Boston.
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