Medical and surgical endoscopists at NewYork-Presbyterian Hospital/Columbia University Medical Center removed a woman's gall bladder using a flexible endoscope with only minimal external incisions. The revolutionary procedure is offered as part of an ongoing clinical research trial and may prove to have advantages, including reduced pain, quicker recovery time and absence of visible scarring. Dr. Marc Bessler led the surgery.

Employing this technique, called NOTES (natural orifice translumenal endoscopic surgery), the endoscope was inserted through the patient's vaginal wall and into her body cavity. Using that scope (with minimal assistance from abdominally-inserted laparoscopic instruments), the gallbladder was detached and removed through the vagina, which was then sutured.

"Advances in minimally invasive surgical techniques over the last 15 years have dramatically reduced the number of open abdominal surgeries necessary - eliminating a great deal of the associated discomfort. This latest revolutionary advance - abdominal surgery through a natural orifice - represents the culmination of this progression," says Dr. Bessler, director of laparoscopic surgery and director of the Center for Obesity Surgery at NewYork-Presbyterian/ Columbia and assistant professor of surgery at Columbia University College of Physicians and Surgeons. "This technique allows us to make smaller and fewer skin incisions. And, in the future, some abdominal surgeries will be possible without any external incisions."
Natural-orifice surgery has been mainly confined to treating conditions within the gastrointestinal tract. However, the NOTES approach goes a step further - into the patient's abdominal cavity. "Internal incisions, such as in the vaginal wall, are less painful and may allow for quicker recovery than incisions in the abdominal wall," says Dr. Bessler.

In addition to gall bladder surgery, NewYork-Presbyterian/Columbia also offers the NOTES approach for appendectomy, abdominal exploration and biopsy.

In the future, NOTES may be performed though the mouth or the rectum. With the mouth, an incision is made in the stomach; with the rectum, an incision is made in the large intestine.

The NOTES procedure was performed by the team of Dr. Marc Bessler, Dr. Dennis L. Fowler (vice president and medical director for perioperative services at NewYork-Presbyterian/Columbia and the United States Surgical Professor of Clinical Surgery at Columbia University College of Physicians and Surgeons) and Dr. Peter D. Stevens (director of endoscopy at NewYork-Presbyterian/Columbia and assistant professor of medicine at Columbia University College of Physicians and Surgeons).

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