Scar-free operation that removes your appendix through your MOUTH



02:09 GMT, 10 April 2012

Open wide — your appendix is about to be removed through your mouth.

It sounds unbelievable, but it’s just one of the ways doctors are using our natural orifices to avoid skin incisions and scarring in surgery.

More than 1,000 patients in Britain, Europe and the U.S. have undergone so-called natural orifice surgery, which many doctors see as the biggest advance since keyhole was pioneered.

Instead of cutting the skin, the new approach uses natural orifices — the mouth, urethra, vagina and rectum — as internal highways to access and remove or repair internal organs.

The first woman to have her appendix removed through her vagina, needed only paracetamol after the procedure and was back at work two days later

The first woman to have her appendix removed through her vagina, needed only paracetamol after the procedure and was back at work two days later

Already, it has been used to remove appendices, gallbladders, prostates and diseased kidneys.

New robotic cutting devices in development that snake their way through body cavities will increase the scope of the technique.

‘With further advancement in medical robotics we are likely to be able to do more and more complex surgery through natural orifices.

'There are many trials under way around the world,’ says Dr Mikael Sodergren, academic clinical lecturer in surgery and specialist registrar in general surgery at Imperial College Healthcare NHS Trust.

The technique offers the multiple attractions of scarless surgery, reduced pain because of fewer and smaller incisions, and lower risk of infections.

Indeed, infections of the superbug MRSA following surgery are usually blamed on the fact that the bacteria can live harmlessly on the skin, but cause havoc when transferred into the body after the surgeon makes an incision.

Doctors also say the technique means patients spend less time in hospital and recover faster.

Reduced pain may also make it possible for some procedures to be carried out under mild sedation, rather than general anaesthetic.

Indeed, the first woman to have her appendix removed through her vagina (in a trial at Yale University), needed only paracetamol after the procedure and was back at work two days later.

In the surgery, termed Notes (natural orifice translumenal endoscopic surgery) and first performed in 2007, the surgeon works with an endoscope — a long, thin flexible tube that carries a light video camera and other equipment. This is inserted into the appropriate orifice.

To remove the gallbladder, the surgeon puts an endoscope through the patient’s mouth and uses a tiny blade to make an incision in the stomach.

They can then gain access to the gallbladder, a small, pear-shaped organ used to store bile, located under the liver.

A balloon is inflated to expand the opening, and the gallbladder is cut into pieces so it fits into the endoscope and can be removed orally.

Even weight-loss surgery can be performed this way.

At the University of California, sleeve gastrectomy, a form of weight-loss surgery that shrinks the stomach by around 70 per cent, has been performed through the vagina. It has also been carried out through the mouth.

Other surgeons, including a team at Imperial College — the only UK NHS trust to offer Notes — have removed the gallbladder and diseased bowel tissue via the vagina.

Once access has been made, an incision is made into the abdomen, which has few nerves, so pain levels are low.

In all cases, tissue or organs removed have to be cut into pieces to fit into the endoscope.

The vagina has been used for the removal of a number of organs, including the appendix, kidney, bladder and colon.

This approach provides better manoeuvrability to upper abdominal organs, such as the liver, gallbladder, spleen, oesophagus and stomach.

The appendix, too, has been removed through the mouth, rectum and vagina.

For reasons that are not clear, incisions inside the body seem to produce less pain than cuts through the skin.

Furthermore, removal of the bowel through a natural orifice, which surgeons say is the procedure that is most likely to become commonplace, seems to reduce the risk of hernias or infections of the abdominal wall.

Theoretically, there should be less pain and adhesion formation (adhesions are the bands of scar-like tissue that can form between two surfaces inside the body and cause them to stick together), says Dr Sodergren.

There have also been attempts to remove the spleen, adrenal gland tumours and even diagnose pancreatic cancer using natural orifice surgery.

‘The outcomes can be as good as the conventional approach, with some advantages, including lower risk of infection,’ says Dr Julian Teare, consultant gastroenterologist at the Imperial College.

‘This is a new and rapidly evolving concept for intra-abdominal operations that offers the potential for a revolutionary advance in patient care.’