Today, I read about a new approach to abdominal surgery that had never occurred to me before. It is called “NOTES” or Natural Orifice Transluminal Surgery, and the application being described is removing the gallbladder through the mouth. Why anyone would want to do that is a mystery to me. Laparoscopic surgery was a huge advance, both for patients’ comfort and, once the learning curve was behind, for safety and postop recovery. The trans-gastric approach seems awfully difficult. The Wall Street Journal refers to trans-vaginal surgery, which has been a preferred method for some procedures for many decades. Hysterectomy and tubal ligation are two examples.
There are other examples of this sort of approach. For example, the pituitary gland is usually approached through the nose. The maxillary sinus is approached through the mouth going above the upper teeth. Both of these routes avoid scarring and are the most direct. There are also trans-anal approaches to some types of rectal tumors and drainage of pelvic abscess can also be done very easily by that route. Once again, it is the most direct and avoids a big incision. Another major operation done through a natural orifice is transurethral resection of the the prostate, or TURP. This and cystoscopy, examination of the urinary bladder by a scope introduced through the urethra, are the majority of urological surgery.
This trans-oral, trans-gastric approach to the gall bladder seems an awfully roundabout approach for little benefit. Laparoscopic surgery is hard enough to learn. This week I take my students to the Surgical Skills Center and we will see if we can do some laparoscopic simulation. I’ll have to see the other in action before I can get enthusiastic about it.