The First Oral Appendectomy

Yes- it’s been done, using NOTES (Natural Orifice Transluminal Endoscopic Surgery). The surgery was done at the Center for the Future of Surgery, University of California San Diego (UCSSD), according to a local news story. It was in February this year that we reported on the use of NOTES to perform a cholecystectomy via the vagina, under the heading “Scarless Cholecystectomy?” The oral route, which was used on a 40-year-old former Marine, is a natural progression. A flexible endoscope was used to enter the stomach, where a small incision was made in its wall to allow access to the appendix. A small incision in the belly button was required to insert a camera, but this was minimal compared to the usual 3 incisions needed for laparoscopic procedure.

Using the oral route through the stomach does present one potential problem. Gastric juices might leak out through the incision in the stomach wall if it isn’t very carefully closed. This means the new procedure can only be introduced gradually, until more experience is gathered. This was one of two initial surgeries of this sort that the Center plans. If the second one goes as well, a pilot study with more patients will be done at the UCSSD Department of Surgery.