Rob Oliver, Jr, MD, over at the Plastic Surgery 101 blog, is one of several pundits who have come out against the idea of Natural Orifice Transluminal Endoscopic Surgery (NOTES). This is the "scarless" surgical approach that has started to show up in the U.S. but originated in Europe.
In Wikipedia, NOTES is described as "an experimental surgical technique whereby "scarless" abdominal operations can be performed with an endoscope passed through a natural orifice (mouth, urethra, anus, etc., then through an internal incision in the stomach, vagina, bladder, or colon, thus avoiding any external incisions or scars."
Writing from the 30,000-foot level, Oliver makes several useful observations about the practicality of NOTES:
Take an operation that is typically performed safely in less then 30 minutes with minimal pain or morbidity and turn it into one that last 3 hours, introduces unnecessary risk, and has no conceivable advantage. What do they call that at the University of California San Diego (UCSD)? They call it progress (!!!!!)
Welcome to the concept of NOTES "Natural Orifices" surgery where intrabdominal surgeries are performed by making a hole thru the stomach, anus, or vagina to work thru versus making several 3-5mm perforations in the abdominal wall with laparoscopic techniques. While ingenuity & creativity is always to be applauded in surgery, at some point you have to do an honest assessment of the risks, benefits, & outcome.
An in-depth critique of a recently publicized NOTES-based appendectomy can be found at the Mexico Medical Student blog.
Last week, Surgeonsblog published an indictment of the technique (tip of the hat to Shannon Leade for finding this):
OK, so surgeons in New York pulled a lady's gallbladder out her vagina. There's a punch line in there somewhere. Anyhow, whereas that particular route is new, the concept of "natural orifice transluminal endoscopic surgery" (NOTES) is not. Or at least not as new. One has to wonder what is the motivation. According to those that advocate such things as pulling an appendix out a person's mouth or anus, the aim is to reduce pain and scarring for patients. I call bullshit. I think the motivation is "Hey, look at me!"
For more information on NOTES, see the latest from Natural Orifice Surgery (NOS) / Scarless Operations Working Group (SLO), a WebMD article cited in Oliver's blog entry, an OpNotes summary page, and a series of online lectures that promote the technique.