Transvaginal cholecystectomy!!

My last post was about creativity and doctors.Well,I have to take a step back here.
White coats are benign, but give a monkey nuts and bolts / scalpels and forceps and he can wreak havoc.
Is there is a limit to where you can insert scopes? Its the surgeon at his sado-masochistic best!! Called Natural Orifice Transluminal Endoscopic Surgery ( NOTES) its a logic of U have holes and you have pipes, and you have your imagination, do what you can.
Well, in a consumer driven market it might well become a next hot thing in surgery. It spares you the scars...However small the laparoscopic incisions might be, it looks ugly when you are working your hours in the gym for that washboard surfacing.
Plus the approach ports are easily accessible-the vagina is the best supposedly.Others proposed are gastroscopic, transcolonic and transvesical.Dr Puntambekar could do a Wertheim hysterectomy through the transvaginal approach. If an entire fetus can pass through- why not a gall bladder?Man if you have seen a Jayle's retractor stretch the vagina you would believe you could turn the person inside out through the vagina!! Males are at a disadvantage here I guess. But they aren't cosmetically inclined too is commiseration enough.

First there was the endoscopes in the 50s and 60s.Then the laparoscopes in the 80s.In 1987,when Philippe Mouret performed the first laparoscopic cholecystectomy. The Anglo-Saxon world called it the "second French revolution" .

The PEG tube is a delectable combination of the transabdominal and the transgastric.It was just time before someone had to think of why not...say.. combine the two....The first was called operation Anubis was presented at the Japanese Congress of Surgery in Osaka on April 6th, 2007.Anubis was the ancient god in Egyptian mythology who restored Osiris to life through mummification using long, flexible instruments. The project was named after this reference.In fact the procedure was formally proposed as early as 2004.And a guy from India, Dr Reddy, has being doing gastroscopic appendectomies since some time it seems.The procedure has come a distance and seems prepared to go a distance. But one has to argue, especially with the appendectomy thing- is this a case of convenience to the patient or subservience to the surgeon's egotistic indulgences? Ok I accept the case of maybe those who can't go through TIVA, but a resounding NO for all others. Why eat an orange with your feeding arm encircling your head? Having mastered the routine spinal stuff,is this a case of wanting to play ball at one higher level.

Other potential advantages proposed include the need for reduced anesthesia requirements and hence shorter hospital stays. Avoiding potential complications of transabdominal wound infections (i.e. "hernias")- I don't buy.And a laparoscopic incision is so small!! Yes post op pulmonary function will be good. But this is a procedure for elective bread and butter procedures on the well fed higher socioeconomic patient group- choles,appendices.This is a procedure that needs to prove its utility beyond the transvaginal approach.