New Surgical Approaches?

Keyhole surgery may be a thing of the past. The latest approach is – wait for it – via ‘natural orifices’. The desire to avoid abdominal wall incisions led to the development of laparoscopic cholecystectomy, appendectomy, and so-on. Regular surgeons hurried off to learn about the new fad, which lasted about 15 years.

Now they’re going to have to learn something new all over again, to avoid those little keyhole scars. Animal studies have been done to explore the practicality of so-called ‘endoluminal procedures’, in which a natural orifice (e.g. the mouth) is used to gain access to the operation site. This is called NOTES – natural orifice transluminal endoscopic surgery.

NOTES is clearly suitable for some surgery on the gastrointestinal tract, such as for treating GERD (gastroesophageal reflux disease). Future use will involve intra-abdominal procedures, where the peritoneal cavity is reached by a hole made in the stomach wall – cholecystectomy (removal of the gallbladder), liver biopsy, and appendectomy. Other orifices (the anus or vagina) may be used, too.  It won’t be long before the techniques spreads from animals to man . . .