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Transvaginal cholecystectomy

Discussion in 'Surgery and Surgical Subspecialties' started by butterfly0660, Apr 25, 2007.

  1. butterfly0660

    butterfly0660 Junior Member 7+ Year Member

    Feb 2, 2006
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  3. eastcoastyall

    eastcoastyall Wisdom Onslaught 5+ Year Member

    Feb 17, 2007
    Many think that NOTES is the wave of the future. I've heard of cholecystectomies and appys being done this way.
  4. SLUser11

    SLUser11 CRS 10+ Year Member

    Feb 22, 2005
    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).
  5. IFNgamma

    IFNgamma Junior Member 2+ Year Member

    Jul 25, 2006
  6. Bitsy3221

    Bitsy3221 5+ Year Member

    Sep 28, 2006
    The Hub
    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.
  7. anes_asmaj

    anes_asmaj New Member 7+ Year Member

    Mar 22, 2006
  8. Skialta

    Skialta 7+ Year Member

    Sep 5, 2003
    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.

  9. LaCirujana

    LaCirujana Smoking Gun 7+ Year Member

    Feb 23, 2002
    Leaving chaos in my wake
    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.
  10. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Administrator Physician Faculty Lifetime Donor Classifieds Approved 15+ Year Member

    Apr 9, 2000
    hSDN Member
    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.
  11. SLUser11

    SLUser11 CRS 10+ Year Member

    Feb 22, 2005
    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.
  12. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Administrator Physician Faculty Lifetime Donor Classifieds Approved 15+ Year Member

    Apr 9, 2000
    hSDN Member
    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:
  13. SLUser11

    SLUser11 CRS 10+ Year Member

    Feb 22, 2005
  14. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Administrator Physician Faculty Lifetime Donor Classifieds Approved 15+ Year Member

    Apr 9, 2000
    hSDN Member
  15. Pilot Doc

    Pilot Doc SDN Angel Moderator Emeritus 7+ Year Member

    Mar 6, 2002
    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.
  16. sleeping

    sleeping 5+ Year Member

    Dec 27, 2006
    In bed
    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:)
  17. 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":

    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
    Last edited by a moderator: Aug 30, 2008
  18. BlackSails

    BlackSails 2+ Year Member

    Apr 4, 2007
    When I read this article, I didnt think "ooh, scarless surgery." I thought "they want to shove long knives into my ass!?"
  19. Blunt? maybe, Vulgar? Maybe

    Could it have been said any better.... I think not:smuggrin:
  20. Syranope2

    Syranope2 Senior Member 10+ Year Member

    Jan 21, 2004
    What exactly does NOTES stand for? I tried looking on google but ended up getting directed to transcription services... :rolleyes:
  21. cytoskelement

    cytoskelement Dr. D.R.E. 5+ Year Member

    Oct 10, 2004
    Natural Orifice Translumenal Endoscopic Surgery
  22. Knight_MD

    Knight_MD Member 5+ Year Member

    May 27, 2006
    NOTES is detailed with videos and animations on

    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.
  23. lillavitez


    Nov 18, 2008
    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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