Or more completely, the Natural Orifice Consortium for Assessment and Research, a group dedicated to investigating and exploring ways to perform surgery through natural orifices, such as the vagina, anus/rectum, and about any other opening nature provides:
Using patients’ natural openings (the mouth, vagina or rectum) as entry points to the body is perhaps the intuitive next step to laparoscopic surgery…
The group’s official acronym is NOSCAR–yes, that there is a gratuitous “S” to make the clever “no scar.” When I read the word “Consortium,” I can’t help but think of some underground, covert organization–guys in dark suits, meeting in secret places, speaking in the language of riddles and subterfuge. About orifices, of course, because you can’t talk about that stuff in the open, it’s gotta be in secret. Can you imagine the higher-ups of this “Consortium” going out for a dinner, paying with some black Amex where the business name is embossed on the card? Maybe there’s even a sphincter watermark that needs to be checked for authenticity… OK, I’m blaming my Lortab this late at night, I apologize…back to the real story at hand. (The truth is out there…)
If we were talking a huge fish-gutting midline incision, perhaps going through one of someone’s tender bits and saving days and days in the hospital and weeks of recovery would be a tradeoff. But the article above (which is from Time BTW–there might be something more scholarly out there, but alas, I don’t have those resources anymore) is talking about a simple appendectomy. An appefrickindectomy!!! Why am I shocked? Because even when comparing “open” vs. laparascopic, we’re talking a 2″ or so incision in the RLQ via the external oblique muscle (surgeons, please correct my newbie knowledge here) or a couple of similar/smaller incisions for the lap technique. How on God’s green earth is cutting open some poor women’s hoo-ha a better surgical choice? I mean maybe–MAYBE–said female works as a swimsuit/lingerie model, but even then, if that’s her professional job, she’ll have professional makeup artists to cover the tiny-ass scars.
But wait, there’s more:
Surgeons Santiago Horgan and Mark Talamini made a small incision in the wall of the patient’s vagina, through which they passed surgical tools and a small camera to the appendix, removing the organ through the same incision. Surgeons also made a small cut in the bottom of the patient’s bellybutton and inserted another camera through it to help guide surgery. The procedure took 50 minutes from start to finish, 20 minutes longer than a standard laparoscopic appendectomy.
Wha?! So they made an umbilical incision anyway, just like lap, so this magically wards off the evil spectre of herniation…how? And almost doubling surgical time is ALWAYS a plus…good going guys! (Note that an open appy is probably 15 minutes for someone who wants to book it out of there (maybe less–never been at a clocked speed test case), tripling the time.
But let’s now turn to that first quote and change the patient to a man. Say a young, otherwise healthy male presents to an ER with an acute abdomen, rebound tenderness, McBurney’s sign, the works. Cocksure eager surgeon dude comes and offers the poor guy a “minimally invasive” option–going through his ass. Last I checked, having a trocar sticking out one’s ass as all these scissors, cautery, etc. get shoved in en route to the appendix (is this in a right decubitus or a jackknife position here, anyway?) is about as invasive as you get.
Yes, the total instrument travel distance in this case is pretty short, and if there’s no serious shit going on, it probably is technically a more direct approach than going through layers of muscle, fascia, etc. Again, I appeal the the surgeons to educate me on basic surgical points here, but isn’t an immediate entry into the peritoneum via the GI lumen–and specifically the rectum of all places–just presenting a contamination problem right away? Yes, there will be abx irrigation, but going through the gut lumen for starters just seems wrong from an aseptic technique POV. Dunno. The whole thing is whack, which is my whole point, so there.