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Saturday, June 2, 2007

The Vagina as Surgical Bastion: fallacious or fabulous?

We have all heard and read of the world's first transvaginal gall bladder operation (cholecystectomy), done at a premiere institute in Strasbourg, France. While the public may react with delight at the thought of surgeries of the future occurring without scars at all, there are troubling thoughts.
The most important question that surgeons are asking is: "after a transvaginal cholecystectomy, can the patient have sex before six weeks?"
Just jokin'!!
On a serious note, the issue here is simple: is the abdominal wall so sacrosanct an organ that we are risking injuries to internal organs? After a transgastric appendectomy, where the operation is done through the mouth, there is a risk of the stomach hole leaking fatally. Is the risk worth it? As always, the response of the surgical community to this new Natural Orifice Surgery (called NOTES or NOS) is predominantly negative. I will just quote John Cage, who said, “I can't understand why people are frightened of new ideas. I'm frightened of the old ones.” Well, here is another quote on this, by Pearl Buck: “You can judge your age by the amount of pain you feel when you come in contact with a new idea.” Since the majority of the surgical community must be old farts and getting-there-old- farts, it is clear that the quote strikes the truth.
Though the surgical community as a whole watches in a mixture of revulsion, fascination and admiration, many patients must be planning to postpone surgeries for a few years till the new no-scar surgery becomes established. Homeopaths are going to have more patients, I am sure!
If you ask me, I think NOS is the surgery of the future, as long as surgery HAS a future. I seriously doubt that it has one, once the nanobots are let loose inside the body. Maybe another 20 years? I have written on the natural orifice surgeries and other futuristic surgical developments in KnowHow, the Telegraph. You can get the original full article in the 'future' label when you check the 'labels' list on the right of this blog-page.
However, on a personal level, it has become important for me to learn this soon. The problem is that the equipment is still not available in the market, being under development, and I am sure will be only slightly cheaper than a nuclear bomb! This is why practising surgery in this age is so difficult: you spend your best years learning something, only to see it becoming obsolete or proven useless just when you have reached some level of competence in it! Is laparoscopic surgery doomed? Will the neo-endoscopist rule? My answer is YES.
And, by the way, we still don't know enough to answer the 'most important question' above, unless we can do a retrospective study on all the pigs who had previously undergone the operation in the last couple of years, and ask them how soon did it feel good and safe to have sex!!


B. Ramana said...

A young boy of eleven points out:
pigs don't have vaginas, sows do!
Kudos, kiddo!! Here is to sex-ed!!

Anonymous said...

Another indication for changing have scarless abdominal surgery

B. Ramana said...

The sex change operation may leave you with a scarless abdomen, but a scar-y perineum as well!