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Tuesday
May042010

Natural Orifice Trials Begin, Surgeons Discover Alternative to Cesarean

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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.

     

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    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.

    May 4, 2010 | Unregistered CommenterMomTFH

    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."

    May 4, 2010 | Registered CommenterJill

    Haha! You are right that they should try removing babies that way. It's much less invasive. Or is it too crude?

    May 4, 2010 | Unregistered CommenterKK

    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!!

    May 4, 2010 | Unregistered CommenterTiffany

    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. :)

    May 4, 2010 | Unregistered CommenterKaren

    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.

    May 4, 2010 | Unregistered CommenterMaureen

    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.................

    May 4, 2010 | Unregistered CommenterTiffany

    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.

    May 4, 2010 | Unregistered CommenterAugusta

    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?

    May 4, 2010 | Unregistered CommenterRenee
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