Scar-Free Surgery Procedures Explored

In this photo provided by the University of Pittsburgh Medical Center, Dr. Carl Snyderman, right, uses an endoscope to view the patient's brain while Dr. Amin Kassam removes a brain tumor through the nose, using special instruments designed for this surgery at the Pittsburgh hospital in September 2006. (AP Photo/Courtesy UPMC) (AP)

PITTSBURGH -- A 4-year-old boy lay on an operating table here 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 devastating consequences. They removed much of the tumor through the boy's nose.

Since then, doctors in New York and in 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.

For abdominal surgeries, going through the mouth, vagina or rectum would avoid the need to cut through sensitive tissues. And deep inside the body, where tissue doesn't feel lasting pain, the procedures themselves might be less traumatic.

Some abdominal surgeries like 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," Rattner said. "It's not trivial, but it also isn't disabling."

Sometimes doctors even pass up one natural body opening for another. On the same day they treated the 4-year-old, doctors in Pittsburgh operated on neck vertebrae of an elderly man through his nose. Usually, this operation would have been done through the mouth.

But going through the nose meant the patient could start eating right away rather than waiting a few days. And he avoided the risks of a feeding tube and a surgical hole in his throat to help him breathe, said neurosurgeon Dr. Amin Kassam.

Doctors at the medical center first reached the spine through the nose just two years ago, he said.

They have even removed brain tumors the size of baseballs through the nose, nibbling at them and withdrawing pieces the size of popcorn kernels.