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In April of last year, surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center made headlines by removing a women's gallbladder through her uterus using a flexible endoscope, aided by several external incisions for added visibility. Now, they have performed the same procedure without a single external incision in what surgeons report may be the first surgery of its kind in the United States.

Led by Dr. Marc Bessler the procedure is offered as part of an ongoing clinical research trial and could prove to have advantages over traditional endoscopic surgery, including reduced pain, quicker recovery time and absence of visible scarring.

Employing this technique, called NOTES (natural-orifice translumenal endoscopic surgery), the endoscope was inserted through a one-inch incision behind the uterus and into her body cavity. Using that scope, the gallbladder was detached and removed through the incision behind the uterus. The area where the gallbladder was removed was then sutured. The three-hour outpatient procedure was performed to treat painful gallstones, which form when bile in the gallbladder hardens into pieces of stone-like material. Removal of the gallbladder is necessary in persistent and painful cases. A small and non-essential organ, the gallbladder stores and releases bile as part of the digestive process.

"This procedure marks the culmination of 15 years of advances that have made surgery less invasive in order to improve safety and reduce recovery time," says Dr. Bessler, director of laparoscopic surgery and director of the Center for Obesity Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of surgery at Columbia University College of Physicians and Surgeons.

Beginning in the late 1980s, surgeons pioneered laparoscopic techniques for gallbladder surgery. Instead of the traditional 10-inch abdominal incision necessary for traditional open surgery, surgeons operated by inserting a camera and surgical instruments through a few small incisions. Nine out of 10 gallbladder surgeries are now performed this way.

Natural-orifice surgery has been mainly confined to treating conditions within the gastrointestinal tract. However, the NOTES approach now goes a step further with this surgery — into the patient's abdominal cavity.

"Internal incisions, such as in the uterus, are less painful and may allow for quicker recovery than incisions in the abdominal wall," says Dr. Bessler.

In addition to gallbladder surgery, the NewYork-Presbyterian/Columbia clinical trial offers the NOTES procedure for appendectomy, abdominal exploration and biopsy. Currently the procedure is only available through the uterus. In the future, NOTES may be performed though the mouth or the rectum, making it available to men.

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 Hospital/Columbia University Medical Center and the United States Surgical Professor of Clinical Surgery at Columbia University College of Physicians and Surgeons) and Dr. Andrew Gumbs, instructor in surgery at Columbia University College of Physicians and Surgeons and surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center.

First developed at Johns Hopkins, the first NOTES procedure is believed to have been performed by surgical teams in India and Brazil before it was available at NewYork-Presbyterian/Columbia.

For more information, patients may call 212-305-9506.

NewYork-Presbyterian Hospital

NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non-sectarian hospital, with 2,242 beds. The Hospital has nearly 2 million patient visits in a year, including more than 230,000 visits to its emergency departments — more than any other area hospital. NewYork-Presbyterian 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's mortality rates are among the lowest for heart attack and heart failure in the country, according to a 2007 U.S. Department of Health and Human Services (HHS) report card. 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 basic, 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, public health professionals, dentists, and nurses at the College of Physicians & Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's College of Physicians & Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the largest medical research enterprise in New York City and state and one of the largest in the United States. For more information, please visit www.cumc.columbia.edu.