Last year, Kurt Roberts, a professor of surgery and a researcher at the Yale School of Medicine, spent four months trying to find a patient willing to undergo an experimental transvaginal appendectomy. Now, it is the patients who are trying to find him.
Two weeks ago, Roberts performed Connecticut’s first-ever transvaginal gallbladder removal on a patient who requested that it be removed in a minimally invasive fashion.
“The gallbladder patient found me through the Web,” he said in an interview. “The patient was reading about gallbladder removals and came to me asking [if I could remove it transvaginally].”
The procedure lasted less than 90 minutes and involved just two incisions — one in the abdomen, one in the top of the vagina. The 21-year-old patient returned home a mere three hours later.
Roberts said transvaginal surgeries are far superior to other surgical techniques that involve more incisions and consequently greater pain, a longer recovery and less pleasing cosmetic results.
“They have almost no postoperative pain and [they are] back to regular activity in basically a day,” he said of patients on whom he had performed purely vaginal appendectomies.
And the procedure may be catching on.
Since performing his first transvaginal surgery last November, Roberts has performed six purely vaginal appendectomies. In fact, he estimated that about 50 percent of those on whom he offers to perform the appendectomy transvaginally opt to have it done that way.
But though Roberts has gained much experience in the past year removing the appendix via the vagina, he said the gallbladder removal presented unique challenges from a surgical standpoint.
For one thing, the gallbladder is significantly farther from the vagina than the appendix.
“It’s relatively easy to reach [the appendix] from the vagina area,” he said. “The gallbladder, it’s a little bit farther away and the instruments you have these days are basically not long enough to reach up there.”
So until new instruments are manufactured, Roberts said, he cannot perform the procedure purely transvaginally and must make at least one quarter-inch incision on the patient’s abdomen. However, this is still a significant improvement over the traditional laparoscopic method, which involves four abdominal incisions.
Robert Udelsman, chairman of the Department of Surgery at the Yale School of Medicine, said he would not be surprised if the transvaginal surgical technique were to become commonplace and Roberts’ transvaginal surgery practice were to “double or triple overnight.”
Nevertheless, he cautioned that it is a polarizing surgical technique and explained that prospective patients tend to fall between two extremes. On one side are those who cannot imagine why anyone would want to have it done any other way, and on the other are those who think only a “very cruel man” could do such a thing, he said.
Transvaginal surgeries are one component of a growing surgical field called Natural Orifice Translumenal Endoscopic Surgery. NOTES surgeries are characterized by their minimally invasive nature, though Udelsman said he prefers to think of them as “kinder and gentler.”
For Roberts, the next step is to do other kinds of surgeries transvaginally. Kidneys, for example, can be removed transvaginally, he said.
Robert Montgomery, chief of the transplant division at Johns Hopkins University School of Medicine, performed a transvaginal kidney removal in February. He said he hopes the ease of the transvaginal surgery urges more individuals to donate organs.
The first transvaginal gallbladder removal took place in May 2007 and was performed at New York Presbyterian Hospital–Columbia University Medical Center on a 66-year-old patient.