What's New
The Future of Surgery
New center at Columbia performs abdominal procedures without external incisions
View from within the scope during retro-uterine cholecystectomy (removal of the gallbladder).The promise of surgery without any external incisions is the wave of the future, thanks to pioneering work being done to perform surgeries through the body's natural orifices. In a new Columbia center dedicated solely to this work, the future is upon us.
Surgeons and researchers at Columbia's new Center for Scarless Surgery are devoted to the advancement of procedures done through natural orifices of the body such as the mouth or the anus. In a step beyond laparoscopic surgery, these kinds of procedures, known as Natural Orifice Translumenal Endoscopic Surgery, or NOTES, offer patients the advantages of no external scars whatsoever, and even less pain and a faster recovery than with laparoscopic surgery (See Healthpoints, Summer 2007 issue).
So far, a team including Marc Bessler, MD, Director of Laparoscopic Surgery, Peter Stevens, MD, Director of Endoscopy, and Dennis Fowler, MD, Director of the Minimal Access Surgery Center, has performed two gallbladder removal operations through the vaginal wall (transvaginal cholecystectomy, or TVC). In these groundbreaking operations, they passed a narrow surgical instrument into the vagina, through a tiny incision in the vaginal wall, and into the abdominal cavity, where they removed each patient's gallbladder. Although they inserted a second instrument through a tiny incision in the belly button in order to provide imaging during these initial procedures, Dr. Fowler believes they will be able to soon eliminate this second scope.
Ultimately, most abdominal operations performed laparoscopically today will be done through natural orifices, Dr. Fowler predicts. "Surgery without external incisions will be part of the future of surgery in the next 25 years," he says.
"This represents the next major step in reducing the invasiveness of surgery."
The primary obstacle to doing more surgeries through natural orifices is that optimal instrumentation doesn't yet exist. It will exist soon, says Dr. Bessler. "The technology is in its infancy," he explains. "Years ago, we knew we could do laparoscopic surgery if we just had the right tools. At that time it took several years to develop the proper equipment. We expect to see a similar course now, but the process will likely unfold more quickly this time." Significant academic and industry effort is focused on developing this technology, and Drs. Bessler and Fowler anticipate that it will take just a few years to devise the right tools for performing not only abdominal, but heart and chest procedures, bariatric (weight loss) operations, as well as kidney, pancreas, and gynecologic surgeries.
In the past, gallbladder surgery required major abdominal surgery that left patients with a long scar (left). Now, natural orifice translumenal endoscopic surgery (right) eliminates even the four small incisions made during laparoscopic surgery.
The Center for Scarless Surgery represents a collaborative effort between surgical and endoscopic specialists. In addition to providing clinical services to appropriate patients, the center stands at the forefront of advancing the technique through research, and in teaching other physicians how to perform the new procedures. The center held the first NOTES teaching conference in December 2007, during which they demonstrated the new techniques and instructed surgeons from around the world. Clinically, Columbia's surgeons currently offer transvaginal cholecystecomy to select patients as an investigational procedure. Meanwhile, they are continually researching ways to improve other natural orifice operations that are not ready to be widely applied. One such procedure under study entails endoscopic repair of gastroesophageal reflux; because the placement of sutures through the stomach is not yet as successful as traditional reflux surgery, Dr. Bessler's team is working to improve the new method so that long-term benefits will exceed those possible in traditional repair.
Visit to the Scarless Surgery Center site.
