Surgeon Removes Gall Bladder Through Mouth         

[June 23, 2007]  PORTLAND, Ore.  (AP) -- An Oregon surgeon has performed gall bladder surgery that removes the organ through the patient's mouth _ the latest example of surgeries that avoid major incisions and rely on the body's own orifices instead.

Dr. Lee Swanstrom of the Oregon Clinic claims the procedure, performed in May on a 35-year old woman at a Portland hospital, was the first of its kind in the United States. He said it had already been performed in Brazil.

Instead of cutting into the abdomen, tiny instruments were sent down the woman's mouth into her stomach. Swanson then cut a small hole in the lining of the stomach to reach the gall bladder, remove it and pull it out through her mouth.

He has since performed two other surgeries with the oral technique. The clinic reports they had speedy recoveries and none of the patients had complications.

While there is some risk of infecting the abdominal cavity with bacteria from the gastrointestinal tract under this technique, Swanstrom said it remains small.

Swanstrom plans to conduct the surgery on 22 more people as part of a research project.

"The success of this surgery will have very positive implications for patient care," Swanstrom said.

Doctors say surgeries that use the body's natural openings speed recovery, reduce pain and eliminate scarring compared to traditional methods.

Physicians in New York conducted gall bladder removals through the vagina earlier this year. A boy's brain tumor was recently removed through his nose in Pennsylvania. And doctors in India say they have performed appendectomies through the mouth.

Doctors say the majority of discomfort and recovery time after conventional surgery is due to the incisions.

The removal of gall bladders once required one large incision across the abdomen, which is still used in some cases, and required about a week of recovery. But in recent decades, most gall bladder surgeries have moved to laparoscopic techniques that use several small incisions and shortens recovery to a few days.

Swanson said he sees "natural orifice" surgeries as the next evolution in surgery.

He said these new methods could potentially allow patients to have the procedures done under sedation rather than general anesthetic. And recovery time could potentially allow patients to return to work the next day.

Gall bladders typically carry bile through the body to aid in digestion. But sometimes they become diseased or filled with gallstones and need to be removed.

Gall bladder removal is the most common major surgical operation in the United States. Each year, more than 500,000 Americans have gall bladder surgery, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Dr. Brant Oelschlager, a specialist in minimally invasive surgery at the University of Washington Medical Center, told The Oregonian there are still some skeptics surrounding such surgeries. But there are many doctors who think it is a positive step for patient care.

"This a pioneering procedure that holds a lot of promise," Oelschlager said.

[Associated Press]