Natural Orifice Trials Begin, Surgeons Discover Alternative to Cesarean
Tuesday, May 4, 2010 at 5:39AM
Fifty points for @midwifeamy on Twitter, who noticed that few tweaks would be needed to turn the article, “Natural Orifice Trials Begin, A Potential ‘Game Changer’ for Hospitals” into a spoof ready for The Onion.
NOTES, or Natural Orifice Translumenal Endoscopic Surgery, is a surgical innovation based on the idea that many procedures could be performed with smaller incisions than ever before, reducing rates of infection, pain and duration of hospital stay than abdominal surgery. In contrast, the goal of modern maternity care is to OPEN MORE ABDOMENS.
The article lists some of the natural orifice surgeries performed.
Removal of the appendix through the vagina in women and through the mouth in men, performed at UCSD. Sleeve gastrectomy, a type of bypass surgery for weight loss, through the vagina, done at UCSD. Repair of achalasia, a disorder marked by difficulty in swallowing, through the mouth, performed at UCSD. Removal of the kidney through the vagina, performed at Johns Hopkins Medical Center. Removal of a portion of the colon through the vagina, performed at Hospital Clínic, University of Barcelona, Spain, and a colonic resection at Massachusetts General Hospital, Boston. Removal of the spleen through the vagina, performed at Hospital de la Santa Creu I Sant Pau Barcelona, Spain. Repair of hernia through the vagina at UCSD. Staging of pancreatic cancer to see if tumor has spread elsewhere in the abdomen, performed at Ohio State University Medical Center.
Let’s write our own Onion-esque article. Leave your paragraph in the comments. Here’s a start:
A group of residents at Kendall Regional Medical Center in Miami, Florida, contacted Natural Orifice Surgery Consortium for Assessment and Research after witnessing an infant emerge from the vagina of a pregnant woman who was experiencing a cramping sensation on the way to the operating room for her scheduled cesarean. Said one resident, “We believe we could be on the cutting edge of a new form of natural orifice procedures that do not involve abdominal surgery.”
Your turn.
Reader Comments (22)
LOL! Love it. Speaking seriously for a minute, I am surprised how upsetting medical students find natural orifice surgery. Especially when it really makes sense - like for a hysterectomy. Or, say, a birth!!
As for Kendall Regional - blarf. I used to drive past that scalpel farm almost every day, and shudder.
I didn't realize it was that controversial. This excerpt from the linked article sums that up:
When NOTES® surgery came on the scene in the U.S. four years ago, some surgeons found it horrifying.
After the first NOTES® gallbladder removal through the vagina in 2007 at NewYork-Presbyterian Hospital/Columbia University Medical Center, Christine Ren, assistant professor at New York University's school of medicine, told the New York Times, "I just think it is crude, and there aren't many things that should be going in and out of the vagina . . . I don't think a gallbladder should be, or those instruments."
Haha! You are right that they should try removing babies that way. It's much less invasive. Or is it too crude?
Ewwwww gross!! You want your BABY coming out of THERE?
Maybe add something about the doctors not knowing if it will go back to normal! I know a few people who get c-sections because of that!!
yes, I want my baby coming out of there. However, I don't want other people's hands, fetal monitors, amniohooks, surgical scissors, etc, going into my vagina. THAT is crude. :)
I find it insane that Johns Hopkins will take your kidney out through your vagina, but they seriously don't seem to be aware that you can birth a baby through it, too. I've never heard of a single person (and I work in public health in Baltimore) who has delivered vaginally at Hopkins.
Based on what *can* be pulled out of your vagina these days, it seems the only thing that *can't* is a baby. *sigh*
Uhh...I was being sarcastic? I have two kids born vaginally and have turned down c-section twice.................
Okay, so I am not a conspiracy theorist. I don't blame the patriarchy for everything. HOWEVER, when it comes to cutting a vagina for ANY reason, I get very pissed. It makes me beyond furious that natural (vaginal) orifice surgery is beating treated so casually. WHY in the world would I want somebody to cut MY vagina so that they can remove a body part or fix something unrelated? If this becomes common, then isn't it only a matter of time that women can't have vaginal births because of previous natural orifice surgery? I just feel like this is just another way women are being devalued and degraded. Do they go through men's rectums to remove kidneys? And (no, I'm not a doctor) how exactly is it less invasive to drag an organ or tumor through an unnatural pathway, than to remove it through an open incision or laproscopically?
Keep your freakin' hands off my vagina.
Much like Augusta, I worry about the ramifications of vaginal surgeries. I was recently reading a great cluster of blog posts (sorry, I can't find them right now - writing this while trying to stop my 11-month old from eating his father's guitar!) about scar tissue on the cervix stopping dilation in labor. The blogs seemed to show that many labor professionals (nurses, OBs, and midwives) didn't know about this, so it leads to a Dx of "failure to progress" and then, of course, to what *appears* to be a necessary cesarean. Knowledgeable providers know the scar tissue can (often) be massaged, broken up, and labor can continue successfully (sounds painful!). How many women will be set up for a future cesarean but using this new surgery technique?
:-O When I first read this, I thought the original link was a spoof, but you were just turning it into a pro-vaginal birth spoof. :-O
Repeating what someone else said -- how might this affect future vaginal births? It is known that surgeries such as D&Cs can lead to uterine scarring, future infertility, increased risk of future ectopic pregnancy, etc. -- how can removing an appendix through the vagina be less invasive than that? Unless the incision is not through the cervix and uterus... but there must be an incision *somewhere*, and quite frankly, I'd rather have a scar on my abdomen or chest than on my vagina -- who knows what else they might mess up while they're in that area!
This thing just makes me shudder!
Tiffany, I knew you were being sarcastic! :)
I guess women today have the unfortunate situation of being lucky just to get a vaginal birth in the first place. I just prefer mine without unnecessary interventions. I was at a birth recently where my client was induced, endured hourly cervical checks (quite painful on her full-throttle Pit), kept on an IV/catheter/internal fetal monitor, directed to push in the lithotomy position, tanked up on analgesics, and finally given a huge midline episiotomy against her explicit refusal so they could do vacuum extraction. Then they kept the baby in the warmer for 2 hours because she was small (having been induced @ 37 weeks - duh!) While my client was being stitched up, the nurse came around and said, "Well, how do you like natural birth?" I wanted to cry. This hospital does 5000 births a year and every one of them is high-intervention. They did let my client push with a squat bar for about 2 contractions, then the OB started huffing and said, "This is taking too long." and made her lie down in the stirrups again so she could cut her.
and honestly, to me that sort of birth is a nightmare and I can almost see where major abdominal surgery starts looking easy to some women, if those are their only two childbirth options. NOT that I endorse elective c/s, but at least you're asleep and you don't have to go through that pain and humiliation and hard work, and if you're in severe pain for weeks afterward anyway.... ??
anyway, my meaning wasn't clear from what I said, so sorry if I was misunderstood. I am planning my second unassisted home waterbirth in October, so I am all about people keeping their hands and instruments out of my body.
and like Augusta and Renee, I too would just as soon have a small abdominal incision instead of one through my vagina. And why is it always the vagina and not the rectum for women as well anyway?
I'm thinking that some of these natural orifice surgeries might happen after the childbearing years, so they wouldn't necessarily have to interfere with it.
Medical professionals funded by the gabillion dollar for-profit pharmaceutical industry are thrilled to announce the ongoing development of NOTES, a type of surgery which removes diseased organs through natural orifices occurring in most humans such as the mouth or vagina. This reduces incisions, infection-risk, potential injury due to traditional surgical mishaps, and recovery time.
“I didn’t realize there was so much cool shit you could do with a vagina,” said Dr. Jack Black. “Back when I was in med school, they were only good for one thing, if you know what I mean,” he continued, as he slapped a passing nurse on the ass for emphasis.
His colleague, Dr. Brian Dingleberry, concurred. “Last week, I got to pull a fucked-up kidney out of a vagina, a spleen from a mouth, and a gall bladder from a vagina, too. It fucking ROCKED. Surgery was getting so damn boring and now it is interesting again. Jack and I have a running bet as to who is going to get a kidney out of an ear canal first, right, man?”
“That’s right, dude, if I don’t get a bunion out of a nostril first,” Dr. Black responded, passing the beer bong back to Dingleberry. When asked why the rectum isn’t used more frequently, Black responded crossly, “What are we, homos? Buttholes are only for one thing, and I’m keeping that between me and my toilet. Jesus.”
When asked about the possibility of a human infant being removed from a vagina, Dingleberry practically choked on his cocktail weenie. “Yeah, maybe in the Stone Age! Why would you want to use a vagina for that? Diseased organs are smaller and more of a challenge, and makes me feel like I should be Dr. McCoy on Star Trak or some shit. Vaginas for BABIES!!!!! HAHA HAHAHAHA!” at which point he fell on the floor laughing and passed out in a puddle bringing this interview to a close.
Rock on, Rachel!! My take, using the post's "starter" paragraph:
A group of residents at Kendall Regional Medical Center in Miami, Florida, contacted Natural Orifice Surgery Consortium for Assessment and Research after witnessing an infant emerge from the vagina of a pregnant woman who was experiencing a cramping sensation on the way to the operating room for her scheduled cesarean. Said one resident, “We believe we could be on the cutting edge of a new form of natural orifice procedures that do not involve abdominal surgery.”
There is a need for more research into the risks of such procedures, however. Preliminary studies based on observational data in other countries suggest that potential concerns might include fewer hospital stays, less need for profitable pharmaceutical and technological interventions, and lower overall costs associated with maternity care. "Until these risks can be eliminated or reduced, we can't recommend widespread adoption of this practice," said Dewey Cheatum-Andhowe, spokesperson for the Council for Money..err...Modern Medicine.
Another potential risk suggested by observers of the new procedure is a disturbing surge in female empowerment.
"The mother seemed oddly happy about it, and proud of herself, despite how much danger she was in," the resident continued. "The infant was just in her uterus, then moved down through her cervix and came out through her vagina, without anyone cutting or grabbing or using medications. She just moved and groaned and pushed, spontaneously, like she was designed for this or something. Like she didn't need us at all." The hospital staff later reported other "difficult" behaviors, like wanting to keep her baby with her, asking questions about standard hospital procedures, and refusing formula samples offered as gifts.
Another resident shuddered at the memory. "Who knows what kind of chaos would ensue if everyone started doing this? People might start coming to the hospital only for emergencies!"
I can't decide who won the internet today. Those are hilarious!
I love these spoof articles! However on the subject of the surgeries through the vagina I have perhaps a different take. While I have some squishy ick factor myself about using the vagina this way, I suspect that what they are thinking is this.
1. I immagine that the only surgeries that would have to go through the cervix wounld be obstetric surgeries. Others would cut through part of the vaginal wall and leave the cervix and uterus intact
2. As for why to use the vagina: The vaginal wall is relatively thin and can get you easily into the peritoneal cavity without cutting though muscle (as in the abdominal wall) causing more painful recoveries
3. Rectal surgeries would be avoided whenever possible because the GI tract is so dirty and we dont want to intoduce all those bacteria into the perintoneal cavity.
4. THe more layers you cut though (as in abdominal surgeries including C sections, the more risk you have of adhesions which can cause future problems.
Now I am not saying I am an expert or that I would jump at the chance to have one of these. But I would definitely think about it if it meant avoiding another abdominal surgery. (This is part of why my daughter was born at home. I wanted to decrease my risk of c section however I could.)
Just a few thoughts
Did I just start my first internet meme? Loving the serious and not-so-serious discussion here!
I'm OK with the careful introduction of natural orifice surgeries but CERTAINLY hope they will measure quality of life outcomes like pain during sex and, as other commenters have mention, affect on future fertility including the ability to birth vaginally.
LOL! Oh, wow. I am cracking up at the spoof stories, especially since I know people doing rotations at Kendall Regional. I almost want to send this to them, but I am afraid they wouldn't get it. *sigh*
I have to agree with Allison. I read a couple articles about NOTES and that is exactly what they said. Love the spoofs too!! You guys are hilarious. :-D