Transvaginal cholecystectomy

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butterfly0660

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Many think that NOTES is the wave of the future. I've heard of cholecystectomies and appys being done this way.
 
Many think that NOTES is the wave of the future. I've heard of cholecystectomies and appys being done this way.

I think the disturbing thing is that the public demand for these procedures is going to precede any solid widescale studies proving safety and efficacy, and it will be forced upon us by the public (kind of like Lap Choles).
 
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Hmmm.....speaking as someone who has a vagina, I will say that given the choice, I would prefer the standard lap chole over the transvag approach (especially since this approach still requires three abdominal port sites). I am going to go out on a limb here and say that the female public will not push for this method, especially since there already is a minimally invasive approach available. NOTES may be the wave of the future, but I don't think it's quite there yet.
 
I am not sure about the whole NOTES thing. You are basically trading three small incisions for the ports for having one incision through an internal organ (vagina, colon, stomach whatever) with what I believe is a much greater risk of complication with the NOTES procedure. I guess we will see.


skialta
 
I am not sure about the whole NOTES thing. You are basically trading three small incisions for the ports for having one incision through an internal organ (vagina, colon, stomach whatever) with what I believe is a much greater risk of complication with the NOTES procedure. I guess we will see.


skialta

I'm with you. The idea of a gastric leak or a (insert viscus here)-vaginal fistula just doesn't make me particularly interested in ever participating in NOTES cases. Give me the ports any day.
 
I'm not sure the public will be clamoring for it...after all, there is generally a big "ick" factor for the public when dealing with the vagina, rectum, etc.

But I'm with you guys/gals on this...I would much rather have 4 or 5 little port scars than running the risk of weakening the walls of my vagina or any other internal organ, and running the attendant risks.
 
I'm not sure the public will be clamoring for it...after all, there is generally a big "ick" factor for the public when dealing with the vagina, rectum, etc.

But I'm with you guys/gals on this...I would much rather have 4 or 5 little port scars than running the risk of weakening the walls of my vagina or any other internal organ, and running the attendant risks.

Well, I disagree. The public will want these. Maybe you think gastric leak or colovaginal fistula, but the public thinks SCARLESS SURGERY. Besides, the transgastric approaches are much less "ick" for the patient.

We don't have to jump on the NOTES bandwagon just yet, but it would be silly of us to think that it's not coming.
 
Well, I disagree. The public will want these. Maybe you think gastric leak or colovaginal fistula, but the public thinks SCARLESS SURGERY. Besides, the transgastric approaches are much less "ick" for the patient.

We don't have to jump on the NOTES bandwagon just yet, but it would be silly of us to think that it's not coming.

You're probably right...I hadn't thought that the general public will dismiss the potential complications and only hear SCARLESS SURGERY - What a miracle! At least twice a day in the office, when proposing surgery, a patient asks if they will have a scar.:rolleyes:
 
Well, I disagree. The public will want these. Maybe you think gastric leak or colovaginal fistula, but the public thinks SCARLESS SURGERY.

And the corollary: there is a very large pile of cash waiting for the surgeon (or gastroenterologist) who jumps on this bandwagon early, spends the first 5 years taking cash patients and the rest of his/her career as an experienced expert.
 
And the corollary: there is a very large pile of cash waiting for the gastroenterologist who jumps on this bandwagon early, spends the first 5 years taking cash patients and the rest of his/her career as an experienced expert.

This will likely happen as it has with: Endoscopy, Colonoscopy, Interventional, Stenting(Vascular Surg), Orthopedics(Trauma surgeons started this field).

I am sure GI will be doing choles, appys next, since they are the most experienced with endoscopies.

I think I will try to improve my techniques for hernias tommorow:)
 
You're probably right...At least twice a day in the office, when proposing surgery, a patient asks if they will have a scar.:rolleyes:

Well, I love the media. I watch the news and I watch the popular TV shows...CSI Miami, etc... I am always impressed at how much they get wrong. I am always impressed at how poorly they word or describe matters. I only wish I could land a cushy consultanting job to help them get something right. I'll give you an example. On one of those CSI programs, the coroner described how the victim died. Apparently a sock was stuffed in their mouth and then tape was applied over their mouth. The coroner said something like, "he/she died of suffocation. everytime they took a breath the sock was sucked further and further down their ESOPHAGUS...". Boy, I could make some money consulting!!! Now let's get to the nice "NEWS material":

link said:
...going through the mouth, vagina or rectum would avoid the need to cut through sensitive tissues. And deep inside the body, where tissue doesn't feel lasting pain, the procedures themselves might be less traumatic...

...Some abdominal surgeries like bowel operations can require patients to spend a week or more recovering at home. With the natural-opening surgery, the theoretical hope is that "they really can go back to work the next day...

I love the suggestion of the vagina and rectum as being less sensitive tissues.
Let's not even mention the fact that abdominal ports plus vaginal incisions or intentional gastric penetration is not going to rush anybody out of the hospital and back to work.

In the end, I think physicians need to get in front on these issues and ensure patients and the media are not driving this train. We fail to educate the public. We have done so with malpractice, we have done so with cancer, and etc... We need to make sure institutional fame and/or "cowboy/cowgirl" fame is not what ends up educating the public and driving new modalities of care. I am all for new treatment options. But, from were I sit (granted a position of ignorance...but more informed then Mrs. Jones wanting a transvag chole), I see a large amount of risk for questionable benefit based on cosmesis. That may be acceptable in elective cosmetic surgery were "better" is not the enemy of good.... but, it should be very unnacceptable in general surgery and the treatment of disease (as opposed to treatment of subjectively small or ugly).

just my dime
 
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You're probably right...I hadn't thought that the general public will dismiss the potential complications and only hear SCARLESS SURGERY - What a miracle! At least twice a day in the office, when proposing surgery, a patient asks if they will have a scar.:rolleyes:

When I read this article, I didnt think "ooh, scarless surgery." I thought "they want to shove long knives into my ass!?"
 
What exactly does NOTES stand for? I tried looking on google but ended up getting directed to transcription services... :rolleyes:
 
What exactly does NOTES stand for? I tried looking on google but ended up getting directed to transcription services... :rolleyes:

Natural Orifice Translumenal Endoscopic Surgery
 
NOTES is detailed with videos and animations on www.websurg.com

I feel it's being introduced as a commercial idea. Somebody may very well be making a fortune out of the new instrument being introduced into the body...etc.

But it does sound amazing IF there are well researched risk vs benefit studies...

You may as well look up "NEMO". That's a NASA funded study where mini-robots where introduced into the body, and remotely controlled to perform an appendectomy.

This operation was done sometime in the past 2 months.
 
Hi everyone!I'm Lilla, a third year medical student from Hungary.I'm doing some research about the acceptance of transvaginal cholecystectomy, so I'm searching for patients who have already had this kind of operation.I'd like to get their opinion about the procedure.Could you recommend me some kind of forums or anything where I can make contact with these patients?
Thanks a lot!It would be a great help!
 
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