Monday, April 23, 2007
Minimally invasive surgery via the vagina
Transvaginal surgery for GI procedures may be the new minimally invasive standard. It takes some getting used to the idea:The idea, he says, is to offer patients operations with less pain and fewer visible scars.Sid Schwab comments:
And the notion makes sense. Such procedures would allow surgeons to avoid cutting through a patient's abdominal wall, which contains a bounty of nerves and takes time to heal.
"The advances are decreased scars — and eventually no scars — decreased pain and quicker recovery," Bessler said.
But critics say the idea of conducting surgery through the vagina is simply too revolting to gain wide appeal.
"To put something like that through the vagina — I just think it is crude, and there aren't many things that should be going in and out of the vagina," said Christine Ren, assistant professor at New York University's school of medicine. "I don't think a gallbladder should be, or those instruments."
So we're talking, according to the rationale, about lessening something already pretty minimal. Moreover, since it's literally impossible completely to sterilize the mouth, rectum, or vagina, any procedure done through them will necessarily introduce organisms into the abdominal cavity. A small number may not always be significant. Still, it's of concern. And the hole that's made needs to be sealed back up safely, especially one in the stomach or colon. Finally there's this: these procedures take longer and afford a less-good view of the target area, unless at least one or two holes are made in the abdomen anyway. That's what was done in the vaginal operation.
Posted by Kevin |
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Comments:
Probably a day late and the proverbial $1 short...but several points to be made in reply:
1) The abdominal wall cuts were made because this was the first time this procedure had been tried on a human, not because it was standard of care. Future procedures would presumably omit this backup.
2) Given that laparascopic surgery involves using a camera as well as instruments, I fail to see how the transvaginal approach would give a lesser viewing screen than the current standard of care. I admit on this point that it's possible the angle of the instruments is sub-optimal compared with the traditional approach. None of the articles have been helpful in clarifying this, and I didn't make it to SAGES this year, where I presume this was presented.
3) Puncturing the abdominal wall is painful no matter how small the cuts. And despite a sterile field, wound infection is frequent. I'd be interested in seeing long-term follow-up on infection rates of the uterine wall, etc, as well as antibiotic and painkiller prescription rates.
4) I was under the impression that natural-orifice-surgery (and transoral surgery in particular) was developed to prevent metastatic spread of cancer to the abdominal wall. If the transvaginal approach was used for cancer resection, I'd rather give up my uterus than my peritoneum.
But as a woman, I can understand Dr. Ren's somewhat instinctive revulsion, and Sid Schwab's comment on bacteria in these orifices.
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1) The abdominal wall cuts were made because this was the first time this procedure had been tried on a human, not because it was standard of care. Future procedures would presumably omit this backup.
2) Given that laparascopic surgery involves using a camera as well as instruments, I fail to see how the transvaginal approach would give a lesser viewing screen than the current standard of care. I admit on this point that it's possible the angle of the instruments is sub-optimal compared with the traditional approach. None of the articles have been helpful in clarifying this, and I didn't make it to SAGES this year, where I presume this was presented.
3) Puncturing the abdominal wall is painful no matter how small the cuts. And despite a sterile field, wound infection is frequent. I'd be interested in seeing long-term follow-up on infection rates of the uterine wall, etc, as well as antibiotic and painkiller prescription rates.
4) I was under the impression that natural-orifice-surgery (and transoral surgery in particular) was developed to prevent metastatic spread of cancer to the abdominal wall. If the transvaginal approach was used for cancer resection, I'd rather give up my uterus than my peritoneum.
But as a woman, I can understand Dr. Ren's somewhat instinctive revulsion, and Sid Schwab's comment on bacteria in these orifices.
# posted by 
: 4:33 PM
: 4:33 PM
