Physician Team at Northwestern Memorial Performs Rare Oral Gallbladder Removal
Physician team is among the first groups in the U.S. to successfully complete natural orifice translumenal endoscopic surgery or NOTES
Utilizing a procedure performed previously at only one center in the U.S., a team of physicians at Northwestern Memorial Hospital successfully removed a patient’s gallbladder through the mouth. Traditional means call for abdominal incisions. However the new technique formally referred to as laparoscopic assisted natural orifice translumenal endoscopic surgery (NOTES) is being characterized by many in the medical profession as laying the groundwork for truly “incisionless” surgery.
"NOTES holds the potential to not only mitigate the pain and discomfort associated with traditional procedures, but may eventually reduce a patient's recovery time to as little as one day by eliminating incisions through the nerve-filled abdominal wall,” said Nathaniel Soper, MD, the Northwestern Memorial surgeon who together with colleagues Eric Hungness, MD and John Martin, MD, a surgeon and gastroenterologist respectively, performed the procedure August 31.
Soper, who is also the Loyal and Edith Professor and Chair of Surgery at Northwestern University's Feinberg School of Medicine, says factors contributing to the growing interest in incisionless surgery include the fact that the stomach and GI tract have very few nerves that register pain. In the future this may allow surgeons to carry out NOTES procedures with the patient under sedation, rather than general anesthesia. The natural orifice technique may also help eliminate the risk of post-operative wound infections or hernias.
“This evolutionary step towards an incisionless surgical technique could reduce costs, speed recovery and reduce pain,” adds Hungness who is also Assistant Professor of Surgery at the Feinberg School. “I see incisionless approaches applying to a wide range of procedures in the future.”
Martin, Director of Endoscopy and Associate Professor of Medicine and Surgery at the Feinberg School, explains that physicians have been conceptualizing natural orifice surgery for years, but current endoscopic devices do not offer a platform for it. By utilizing a stable operating platform, instruments can be manipulated to view, cut, grasp, and suture tissue without ever cutting into the skin, which may be attractive to some patients as these procedures can eliminate all visible scars, and eliminate much of the pain that may occur in abdominal surgery involving skin incisions.
Medical devices that were utilized for this procedure included the EndoSurgical Operating System™ by USGI Medical and endoscopic equipment made by Olympus™. For this case, three small laparoscopic ports were used in conjunction with the endoscopic system in order to assess the safety of the procedure and to assist in refining the technique. Current risks include proper suturing of the incision that is created in the stomach, as if not closed properly, complications could occur. The team expects to gradually eliminate these external ports in future procedures.