More Scarless Surgery Options

Following on the reports of an oral appendectomy, examples of NOTES (Natural Orifice Transluminal Endoscopic Surgery) are coming thick and fast. First, Drexel University has announced that their surgeons have done over 100 cases of what they call Single Port Access ( SPA) surgery. This involves using a single entrance incision in the patient’s umbilicus (belly-button) and sophisticated laparoscopic instruments. Among the organs that have been removed in this way are gallbladders, ovaries, abdominal masses, spleens and appendices.

Second, a Portuguese surgeon reported to the European Society of Urology that he had explored nephrectomy (removal of a kidney) using NOTES – in this case combined incisions through the stomach and the bladder. Pigs were used to model this approach. What the surgeon had to admit, however, was that these two incisions were not large enough to allow removal of a kidney – just it’s mobilization and release. I don’t doubt, however, that nephrectomy will soon be added to the list of procedures that will be conducted “scarlessly”. This sort of approach has offered surgeons a similar spurt in new activity to that they experienced with the introduction of laparoscopy. Smaller incisions offer the promise of earlier discharge from hospital with less risk of complications – and a smaller or invisible scar.