By Mass Communication Specialist 1st Class Anastasia Puscian, Naval Medical Center San Diego Public Affairs
SAN DIEGO-Naval Medical Center San Diego (NMCSD) marked a major milestone as the first Navy military treatment facility to remove a gallbladder using natural orifice translumenal endoscopic surgery (NOTES) May 11.
NOTES is an advanced surgical technique for abdominal surgeries that does not scar the patient. Surgery is performed with an endoscope passed through a natural orifice of the body such as the mouth, vagina or anus. An internal incision is then made in the stomach, vagina or colon to the gain access to the surgical site. By performing this type of procedure it avoids making major incisions through skin, muscle and nerves thus significantly decreasing post-operative pain.
There are two types of procedures currently performed through NOTES, the removal of the gallbladder or appendix.
Cmdr. (Dr.) Gordon Wisbach, director of Minimally Invasive and Bariatric surgery at NMCSD performed a transvaginal cholecystectomy (removal the gallbladder through the vagina) with the assistance of Cmdr. (Dr.) Amanda Simsiman, head of urogynecology. As part of the Institutional Review Board (IRB) approved protocol, one incision is made through the belly button to insert a small camera to ensure safety during the new procedure.
All clinical studies at NMCSD need to be presented to the IRB board for approval before any procedure can take place to assure patient safety. All NOTES procedures are performed under IRB-approved protocol in the U.S. NMCSD strictly follows this policy.
"We already do GYN surgeries via the vagina so this is not really a GYN advancement," said Simsiman. "This however, is an exciting development for general surgery in that it will allow patients to have no scarring on their abdomen. Typically gallbladders are removed via laparoscopy which does leave three or four small scars on the abdomen."
The surgery proved to be a success, the four person surgical team completed the planned procedure in three hours. The patient recovered without any complications and returned to normal activity one week later. The benefits of performing NOTES are patients experience quicker recovery times, reduced pain and avoid post surgery complications associated with abdominal incisions.
"With a standard way of removing the gallbladder the recovery time is two weeks of convalescent leave and then two weeks of limited duty status if you are active duty, a full month that a service member is not mission ready," said Wisbach. "With NOTES a patient can be full duty within a week."
In 2007, the University of California San Diego (UCSD) Medical Center was the first hospital in the Southwest region to complete a NOTES procedure. NMCSD was able to bring this advanced medical service to beneficiaries through the collaboration and training from UCSD medical staff.
"We [NMCSD] are at the cutting-edge of minimally invasive surgery for the benefit of our patients," said Wisbach. "As we develop this technique further we expect it to become a more common technique for gallbladder removal surgery in the female patient. The NOTES technique, as the final frontier of minimally invasive surgery, has many apparent benefits and many unforeseen advantageous applications. Our intent is to be a part of this exciting advancement in surgery."