Gallbladder removal through vagina offers minimally invasive alternative

Chicago 25 February 2009Physicians at Northwestern Memorial Hospital successfully removed a patient's gallbladder through the vagina, making them the first in the Midwest and the third in the country to perform the innovative procedure. The technique, known as NOTES - natural orifice translumenal endoscopic surgery - is gaining in popularity and has been characterized by many in the medical profession as laying the groundwork for truly "incisionless" surgery.

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In NOTES cases, surgeons use the vagina or mouth in patients to remove organs such as the gallbladder, kidney and appendix. When the gallbladder is removed through the vagina, a thin, flexible snake-like device, called an endoscope, is inserted through a small incision in the vaginal wall and into the abdomen. Currently, laparoscopic assistance is used as a small camera is also inserted through an incision made in the patient's belly button to help guide surgeons. The organ is then surgically resected and taken out the vagina.

"Millions of women in the United States suffer from gallbladder disease, and many of those women will eventually have to undergo a surgical procedure to remove the organ, which is often painful and can have a lengthy recovery time", stated Eric Hungness, MD, a minimally invasive gastro-intestinal surgeon at Northwestern Memorial Hospital who led the team who performed the surgery. "NOTES reduces the number of and may eliminate the need for abdominal incisions compared with traditional laparoscopic surgery, and may reduce pain and shorten recovery time for patients. This technique may also eliminate the risk of post-operative wound infections or hernias."

Heather Lamb, a junior high math teacher, did not think twice about having the ground-breaking procedure done at Northwestern Memorial on February 2, 2009. Heather Lamb, diagnosed with gallstone disease, had been experiencing severe abdominal pain for weeks that was not responding to dietary changes, and surgery was her only option. "I went home the day of surgery and felt nothing more than a little discomfort the following day", she stated. "I returned to work a few days later and I'm feeling great."

"Transvaginal surgery is one of the safest alternatives to traditional laparoscopic surgery because it uses an easily accessible natural orifice that has proven safety for over a century", commented Janet Tomezsko, MD, chief of urogynaecology at Northwestern Memorial and a gynaecologic surgeon who assisted with the procedure. "Transvaginal procedures demonstrate reduced risk of damage to tissue and surrounding structures."

Approximately 50 NOTES procedures have been done in the United States since 2007, but that number is expected to dramatically increase over the next few years, according to Nathaniel Soper, MD, chair of surgery and director of the minimally invasive surgical programme at Northwestern Memorial. "NOTES is well-received by patients and holds the potential to replace traditional laparoscopic surgery for a wide range of procedures in the future", added Dr. Soper.

Drs. Hungness and Soper, along with John Martin, MD, director of the gastro-intestinal lab at Northwestern Memorial, were also the second team of surgeons in the United States to perform NOTES to remove a gallbladder through the mouth of a patient in August 2007. They are the only team in the country performing gallbladder removal through both the mouth and vagina, and will begin utilizing NOTES for a broader range of applications, including appendix removal through the vagina, in the coming months.

Northwestern Memorial Hospital is one of the United States' premier academic medical centres and is the primary teaching hospital of the Northwestern University Feinberg School of Medicine. Along with its Prentice Women's Hospital and Stone Institute of Psychiatry, the hospital comprises 873 beds, 1603 affiliated physicians and 7144 employees. Northwestern Memorial is recognized for providing exemplary patient care and state-of-the art advancements in the areas of cardiovascular care; women's health; oncology; neurology and neurosurgery; solid organ and soft tissue transplants and orthopaedics.

Northwestern Memorial possesses nursing Magnet Status, the United States' highest recognition for patient care and nursing excellence, and it is listed in 10 clinical specialties in U.S. News & World Report's 2008 "America's Best Hospitals" guide. For nine years running, it has been rated among the "100 Best Companies for Working Mothers" guide by Working Mother magazine. The hospital is a recipient of the prestigious National Quality Health Care Award and has been chosen by Chicagoans as their "most preferred hospital" according to the National Research Corporation's annual survey for 10 years.


Source: Northwestern Memorial Hospital

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