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Natural Orifice Translumenal Endoscopic Surgery [NOTES]
 
Incisionless Surgery with Natural Orifice Techniques
 
In the next step beyond laparoscopic surgery, surgeons and medical endoscopists are now working together to perform surgery without any external incisions or scars.
In a first-of-its-kind operation in the U.S., surgeons and a medical interventional endoscopist at New York - Presbyterian Hospital / Columbia University Medical Center have removed a woman’s gallbladder with flexible instruments passed through her vagina. This experimental procedure was part of a study being done to determine whether people will have less pain and scarring, and faster recovery, if abdominal surgery is performed through a natural orifice rather than through incisions in the belly.
Natural Orifice Translumenal Endoscopic Surgery, or NOTES, is a new method of performing minimally invasive surgery through the mouth, anus, or vagina. Although a small internal incision must be made in the vaginal wall to access the gallbladder or other internal organ, such incisions should hurt less than traditional abdominal incisions because those tissues are less sensitive to pain than abdominal muscles.
Although laparoscopic surgery has afforded patients tremendous benefits in reducing trauma and shortening recovery, there is still significant room for improvement.
In this procedure, the team made just three tiny laparoscopic incisions in the patient’s abdominal wall, in contrast to the four substantially larger incisions usually required during a traditional laparoscopic cholecystectomy. "The patient felt almost no pain upon recovery, other than some minor discomfort at one laparoscopic site. This approach will provide patients the benefit of reduced pain, faster recovery time and fewer scars than the traditional laparoscopic alternative.