Removal of gallbladder through vagina offers minimally invasive alternative

Feb 25 2009

Physicians 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.

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," said Eric Hungness, MD, a minimally invasive gastrointestinal 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. 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 said. "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," comments Janet Tomezsko, MD, chief of urogynecology at Northwestern Memorial and a gynecologic 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 U.S. 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 program 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," adds Dr. Soper.

Drs. Hungness and Soper, along with John Martin, MD, director of the gastrointestinal 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.