Thursday, May 03, 2007

Turn Up The Happy Gas

Here's another slightly strange, but cool, medical breakthrough for you. This time around, our breakthrough involves upgrading techniques for abdominal surgery. Most of us are probably aware of how some surgeries have changed in recent years. Procedures that used to involve cutting a patient's abdominal wall clean open, to gain access to those reclusive internal organs, have been improved with the advent of laparoscopic surgery, where abdominal incisions are tiny, scars are miniscule and recovery time is much shorter than with traditional surgical methods. Such surgeries involve a laparoscope, a tiny camera inserted to examine the abdominal cavity so doctors can see what's going on and repair or remove damaged organs, via other tiny little incisions and long, flexible instruments. Such "keyhole" surgery has made necessary operations much easier for many a grateful patient. There's a new kind of surgery coming to operating rooms around the world, however, that eliminates the external incisions completely, leaves no visible scars, has minimal recovery time and doesn't even require general anesthetic.

Duncan Graham-Rowe, at, says this revolutionary new technique is called transgastric surgery, or natural orifice translumenal endosurgery--NOTES for short. NOTES takes a whole new approach to the problem of getting inside a patient, quite literally. Instead of entering the abdomen through surgical incisions made externally in the skin and muscle walls, the cameras and surgical tools find their way into the abdominal cavity via the patient's mouth. An incision is made in the stomach from the inside; the surgical instruments pass into the abdomen through this opening, and tissue that needs to come out does so via exactly the same route that food goes in--in reverse, of course:

To some it may sound disgusting, to others the prospect of scar-free surgery may sound too good to be true. Either way it's coming. In the past couple of weeks three separate surgical teams say they have carried out NOTES procedures on humans - surgical firsts for both Europe and the US. And doctors in India say they have performed appendectomies through the mouth.

This transgastric procedure offers a lot of advantages to conventional, or even keyhole surgery: less pain (the stomach apparently has fewer nerve endings than the skin), less sedation (which Duncan-Rowe points out is good for the elderly and infirm), less risk of infection (theoretically), due to avoiding the bad bugs that live on the skin, as well as the disinfecting power of stomach acid, and--an important gain for the workaholics of the world--by far less recovery time:

"Even with keyhole surgery, patients stay off work for several days," says Lee Swanstrom, director of the Oregon Clinic in Portland, US, which specialises in gastrointestinal and keyhole surgery. "With NOTES they could go back to work the same day."

Good grief, that's fast. Gives a whole new meaning to "same day service." Now this last "advantage" might be a mixed blessing for some people who, for example, were hoping that their gall bladder surgery would help them avoid the big cubicle shuffle at the office, or going to the boss' daughter's ballet recital. Be that as it may, most of us would see a rapid spring back to full strength as a big plus. A few years ago, a friend and I had the same surgery performed, only mine was laparoscopic and hers was a full stomach incision. Her surgery came first, and I watched her long and painful recovery with a great deal of sympathy, because it was really hard. She suffered a lot. When it came time for my surgery, I was dreading a similarly unpleasant experience, but all that dread was wasted. While I still had a fairly long recovery time, mostly due to the five-and-a-half hours of general anesthesia the surgery entailed, there was very little pain, because of the tiny, tiny, unbelievably small incisions my doctor used to get at my innards. I'd take my surgery over my friend's hands down; if you added the less intense anesthesia, so the recovery could proceed even faster, that would just be all that much better.

Needless to say, the downside is the "ick" factor. Who really wants to have their appendix come out of their mouth? While they're somewhat awake, no less? I might request that the docs turn on the happy gas for that part of the procedure, although, now that I think about it, even that might not be necessary. When I had my surgery they put something in my IV to make me forget everything that happened from the time they wheeled me out of the waiting room till when I woke up in recovery. If you can't remember the icky bits, there's not really a need for the happy gas, is there? It was actually very frustrating to me that they stripped me of memories that I wanted. I find all this medical stuff fascinating, and probably would have watched the whole surgery, if that had been an option. To have a complete blank in my memory, when I had a prime opportunity for first-hand knowledge of what goes on behind the scenes in Surgery World is very frustrating. They didn't even film it for me, so that I could watch it after the fact!! To give the doctor credit, though, she did take some lovely photos of my insides, which I perused with great interest once the drugs wore off. That was of some comfort to me, even if I'd rather have the memories. I have to confess, though, I don't think even I would want to remember having my spleen come out my mouth. Turn up the happy gas, please (but shoot some video in case I change my mind.)