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Medical and surgical endoscopists at NewYork-Presbyterian Hospital/Columbia University Medical Center removed a woman's gall bladder using a flexible endoscope with only minimal external incisions. The revolutionary procedure is offered as part of an ongoing clinical research trial and may prove to have advantages, including reduced pain, quicker recovery time and absence of visible scarring.

Dr. Marc Bessler, who led the recent surgery, will make a presentation on the procedure at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) in Las Vegas on Sunday, April 22, 10:00–12:30 a.m.

Employing this technique, called NOTES (natural orifice translumenal endoscopic surgery), the endoscope was inserted through the patient's vaginal wall and into her body cavity. Using that scope (with minimal assistance from abdominally-inserted laparoscopic instruments), the gallbladder was detached and removed through the vagina, which was then sutured.

"Advances in minimally invasive surgical techniques over the last 15 years have dramatically reduced the number of open abdominal surgeries necessary – eliminating a great deal of the associated discomfort. This latest revolutionary advance – abdominal surgery through a natural orifice – represents the culmination of this progression," says Dr. Bessler, director of laparoscopic surgery and director of the Center for Obesity Surgery at NewYork-Presbyterian/Columbia and assistant professor of surgery at Columbia University College of Physicians and Surgeons. "This technique allows us to make smaller and fewer skin incisions. And, in the future, some abdominal surgeries will be possible without any external incisions."

Natural-orifice surgery has been mainly confined to treating conditions within the gastrointestinal tract. However, the NOTES approach goes a step further – into the patient's abdominal cavity. "Internal incisions, such as in the vaginal wall, are less painful and may allow for quicker recovery than incisions in the abdominal wall," says Dr. Bessler.

In addition to gall bladder surgery, NewYork-Presbyterian/Columbia also offers the NOTES approach for appendectomy, abdominal exploration and biopsy.

In the future, NOTES may be performed though the mouth or the rectum. With the mouth, an incision is made in the stomach; with the rectum, an incision is made in the large intestine.

The NOTES procedure was performed by the team of Dr. Marc Bessler, Dr. Dennis L. Fowler (vice president and medical director for perioperative services at NewYork-Presbyterian/Columbia and the United States Surgical Professor of Clinical Surgery at Columbia University College of Physicians and Surgeons) and Dr. Peter D. Stevens (director of endoscopy at NewYork-Presbyterian/Columbia and assistant professor of medicine at Columbia University College of Physicians and Surgeons).

All three attended a 2005 summit meeting on NOTES led by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and American Society of Gastrointestinal Endoscopy (ASGE). "We determined that, for now, the technique should only be offered as part of a supervised clinical research, and by a team of surgeons and advanced therapeutic endoscopists," Dr. Bessler says.

For more information, patients may call 866-NYP-NEWS.

NewYork-Presbyterian Hospital

NewYork-Presbyterian Hospital – based in New York City – is the nation's largest not-for-profit, non-sectarian hospital, with 2,335 beds. It provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children's Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/Allen Pavilion and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health-care institutions in the world, the Hospital is committed to excellence in patient care, research, education, and community service. It ranks sixth in U.S.News & World Report's guide to "America's Best Hospitals," ranks first on New York magazine's "Best Hospitals" survey, has the greatest number of physicians listed in New York magazine's "Best Doctors" issue, and is included among Solucient's top 15 major teaching hospitals. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons.

Columbia University Medical Center

Columbia University Medical Center provides international leadership in pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, nurses, dentists, and public health professionals at the College of Physicians & Surgeons, the College of Dental Medicine, the School of Nursing, the Mailman School of Public Health, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions.