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Surgery Can Avoid Cut In Skin

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The Washington Post

Published: September 24, 2008

When Albert Pagliuca got gallstones, his surgeon offered to remove his gallbladder with a new operation designed to hurt less, get him back to work more quickly and leave no visible scars.

However, there was one catch: Doctors would pull the organ out through his mouth.

"I kept thinking, 'What if it gets stuck in my windpipe? What if I choke on it?' "said Pagliuca, 45, of suburban Chicago.

After doctors guaranteed that would not happen, he agreed, becoming one of several dozen Americans who have undergone experimental procedures that could take minimally invasive surgery to a new level: operations that do not cut the skin open.

Instead, surgeons enter the body through a "natural orifice."

"It's potentially a very big deal," said Nathaniel Soper, surgery department chairman at Northwestern University.

"This could be the endpoint in innovation, going from big incisions to little incisions to no incisions at all, which is the Holy Grail when things have to be removed from the body," Soper said.

Many surgeons are enthusiastic about the possibilities, but some question the need for the new procedures when safe, only slightly invasive alternatives exist.

They also fear that doctors will rush ahead before they have perfected their techniques and made sure that the benefits are worth the risks.

Proponents contend that they are aware of the pitfalls and have taken steps to prevent them. Two key medical specialties joined together to try to ensure the operations are carefully studied before becoming widespread, in the hope of avoiding the complications caused by laparoscopic surgeries in the early 1990s.

"It's very promising," said David Rattner, chief of general and gastrointestinal surgery at Massachusetts General Hospital. "The approach - called NOTES, for natural orifice transluminal endoscopic surgery - seeks to move beyond arthroscopic and laparoscopic techniques, which for many procedures replaced large incisions with several small ones. The results were shorter hospital stays and recovery time, reduction in pain and risks and much smaller scars.

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