Pittsburgh – A 4-year-old boy lay on an operating table a few weeks ago with a tumor that had eaten into his brain and the base of his skull. Standard surgery would involve cutting open his face, leaving an ugly scar and hindering his facial growth as he matured.
But doctors at the University of Pittsburgh Medical Center knew a way to avoid those consequences. They removed much of the tumor through the boy’s nose.
Since then, doctors in New York and France have announced they removed gall bladders through the vaginas of two women. And doctors in India say they have performed appendectomies through the mouth.
It’s a startling concept and a little unpleasant to contemplate.
But researchers are exploring new ways to do surgery using slender instruments through the body’s natural openings, avoiding cutting through the skin and muscle.
Many questions remain about that approach. But doctors say it holds the promise of providing a faster recovery with less pain and no visible scars. And in the brain, it can avoid a need for manipulating tissue that could disturb brain and eye function.
Some abdominal surgeries such as 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,” said Dr. David Rattner of Massachusetts General Hospital. “It would be like going to the dentist and getting a root canal. It’s not trivial, but it also isn’t disabling.”
On the same day they treated the 4-year- old, doctors in Pittsburgh operated on neck vertebrae of an elderly man through his nose.
Doctors have even removed brain tumors the size of baseballs through the nose, nibbling at them and withdrawing pieces the size of popcorn kernels.
The key to operating through body openings is specialized slender instruments that can be inserted into the natural channels, along with devices that provide light and a video camera lens at the site of the surgery. Doctors watch their progress on video screens as they manipulate the instruments.
It’s much like laparoscopic surgery, which revolutionized the operating room more than 15 years ago. For many operations, long incisions have been replaced with three or four holes, each maybe a quarter-inch to a half-inch wide. The natural-opening approach holds the promise of going a step beyond that by eliminating the need for those punctures.
