Open your mouth so I can take out your appendix.

April 20, 2008 6:07 AM

Natural Orifice Transluminal Endoscopic Surgery (or NOTES) became a reality for humans when in 2006, Rao and Reddy 9 of the Asian Institute of Gastroenterology, Hyderabad, India, stunned the medical fraternity when they presented 7 cases of successful transoral, transgastric appendicectomies.”

Natural orifices include all orifices naturally enough. The newer transvaginal procedures surgeons like Christina Ren find “repulsive". ( scroll down)

It wasn’t so long ago that people were “iffy” about minimally invasive surgeries and the list of possible procedures has increased rapidly. It’s only a matter of technique and instruments before many more procedures are done through natural orifices.

posted by Wilder (19 comments total)

I just threw up ( my appendix) in my mouth a little bit.
posted by srboisvert at 6:18 AM on April 20, 2008

Having had a number of major surgeries I can say there is no such think as a successful surgery, every surgery leaves problems behind from the procedure itself. Minimal invasion is IMO a huge leap forward but I suspect it will take a while for the car-mechanic western mentality to catch up. Not surprised it is more popular in the east where they have a more holistic view.
posted by stbalbach at 6:21 AM on April 20, 2008

Having had a number of major surgeries I can say there is no such think as a successful surgery, every surgery leaves problems behind from the procedure itself.

If I thought you were correct that they all leave problems behind, I might argue that a successful surgery is one that leaves the patient with a lesser problem than before. However, I have also had a number of major surgeries, some of which didn't leave problems behind, and most of the ones that didn't were still 'successful' by the standard I just mentioned. But then, I think my scars look cool.
posted by spaceman_spiff at 6:33 AM on April 20, 2008

I might argue that a successful surgery is one that leaves the patient with a lesser problem than before.

My dad was a surgeon and his motto was "If there is a non-surigical option, take it." When he retired a few years ago, I asked him what he was most proud of and he tells me "35 years of surgery and I never harmed a patient. Came close a few times...."
posted by three blind mice at 6:48 AM on April 20, 2008

spaceman_spiff most of mine have been bone related and that stuff usually doesn't fully heal right. More than predict the weather, it tends to send me howling. It's a mugs game to guess how things would have turned out otherwise, no doubt a different set of problems. Also I think anesthesia does something to the brain, not sure what but I never felt the same afterwards.
posted by stbalbach at 6:55 AM on April 20, 2008

One surgeon's thoughts.
posted by prefpara at 8:25 AM on April 20, 2008 [1 favorite]

I'm fascinated by the quite extreme reactions I've read. For example, "As a woman I find it very invasive, physically and emotionally. To me it’s quite distasteful. You will really have to prove to me that there is a benefit." Dr Chistina Ren.

This was the reaction to the transvaginal gallbladder discussed in the blog above from prepara (thanks, that was the information I was looking for!)
The benefits are quite evident once the procedures become more common. Less hospitalisation, less recovery-time, potentially less opportunities for infection, many of these have resource as well as health implications.

The advantages of lap over open abdominal procedures are well known. There's almost a political element to Dr Ren's repulsion based, one assumes, on the fact that the route is through the uterus.

It reminds me of the early reactions to Marshall and Warren's work on helicobacter pylori.
posted by Wilder at 8:56 AM on April 20, 2008

I don't know Wilder, I can definitely relate to the squick factor. Personally, I'd rather have complications in my abdomen rather than get my reproductive organs unnecessarily involved. I see the benefit of minimally invasive surgery, but I don't see great advantages with this, except for the absence of visible scarring and possible slightly reduced healing. The increased infection risk (I assume) from difficult to sterilize areas would probably outweigh that for most cases.

Oh and FYI the first link requires you to log in, so people may be skipping that hassle and only reading the contradictory evidence.
posted by fermezporte at 10:19 AM on April 20, 2008

spaceman_spiff most of mine have been bone related and that stuff usually doesn't fully heal right.

I'm not disputing that surgeries can go wrong, but my spinal fusion has never caused me any problems (well, the scar itches sometimes), and I don't think my two bilateral osteotomies have either. It's tricky stuff, yes, and it can be really bad if it goes wrong, but I think it's over the top to say there are no successful surgeries.

I'll agree with 3BM's dad, though - a non-surgical option is always better. (That said, my most recent surgery - not bone related - had a non-surgical option, albeit with less effective results, and I was happy I chose the surgery.)
posted by spaceman_spiff at 10:26 AM on April 20, 2008

It is a very primal and deep psychological 'rule' not to let anything foreign enter any of your own orifices that you have not thoroughly vetted beforehand. These procedures simply reaches down and touches a very basic instinct.
posted by Catfry at 10:41 AM on April 20, 2008

The first link requires registration info. Good luck pulling that out of my ass.
posted by bigskyguy at 10:41 AM on April 20, 2008 [2 favorites]

Hopes dashed this wasn't a SLYTP.
posted by stevil at 2:03 PM on April 20, 2008

It reminds me of the early reactions to Marshall and Warren's work on helicobacter pylori.

You forgot to mention the early reactions to Semmelweis and hand washing, and Pasteur and vaccination. Or does every medical innovation get a little push-back from the establishment and first... and eight times out of ten deserve it?
posted by Faze at 2:48 PM on April 20, 2008

Apologies all, I was able to read the abstract today but now registration is required.
Better article here in any case .

Femzeporte, I take your point about the squick factor and you would expect the infection rates to be higher. I can find no comparative infection rates for transoral, but the early comparisons of infection rates in transvaginal are interesting.
(Admittedly this is the transvaginal route in the hands of experienced gynaes)
posted by Wilder at 3:26 PM on April 20, 2008

I like the fact that it's referred to as "Operation Anubis" (because Anubis used flexible long medical instruments) but I keep misreading it and that is what's bothering me. Otherwise, I'm glad doctors are moving away from "big scar-big surgeon" before I'm old enough to need a lot of surgery.
posted by artifarce at 3:51 PM on April 20, 2008

nice discussion but I'm feeling too squeamish to click the links.
posted by sswiller at 4:05 PM on April 20, 2008

I thought the mechanisms our bodies had to find infections in the mouth (or vagina) were more effective than fighting wound infections. Any permanent opening into the body should be better at fighting infection than a wound right?
posted by BrotherCaine at 5:39 PM on April 20, 2008

BrotherCaine: I thought the mechanisms our bodies had to find infections in the mouth (or vagina) were more effective than fighting wound infections. Any permanent opening into the body should be better at fighting infection than a wound right?

The issue isn't that the wound left in the vagina heals correctly (although that obviously is an issue, since it would obviously be harder to monitor) it's that you're introducing all the bacteria that exists in the vagina directly into the abdominal cavity-- there's no way you can effectively sterilize it, so therefore you're infection risks are higher.

Compare that with a standard key-hole surgery from the outside of the abdomen, a place where you can sucessfully sterilize before, during and after the operation and you should see that the risk for standard keyhole over NOTES is smaller.

Especially because it seems that during this NOTES operational, they had to cut into the abdomen anyway. So all that happened, with the increased risk, was the patient traded one of the small scars on her abdomen for scarring within her reproductive machinery.
posted by Static Vagabond at 6:06 AM on April 21, 2008 [2 favorites]

great stuff, thanks
posted by matteo at 11:04 AM on April 22, 2008