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)

However, entry through the nose isn't feasible for brain tumors in some locations. That's why doctors had to remove the rest of the 4-year-old's tumor another way, by going through the side of his skull. They used an incision designed to hide behind his hairline.

The key to operating through body openings is specialized slender instruments that can be inserted into the natural channels, along with devices that provide light and a video camera lens at the site of the surgery. Doctors watch their progress on video screens as they manipulate the surgical instruments.

Sound familiar? It's much like laparoscopic surgery, which revolutionized the operating room more than 15 years ago. For many operations, long incisions have been replaced with three or four holes, each maybe a quarter-inch to a half-inch wide. That has vastly reduced pain and recovery time.

The natural-opening approach holds the promise of going a step beyond that by eliminating the need for those punctures.

"Getting rid of them completely is going to be not an evolutionary step, but a revolutionary step," said Dr. Marc Bessler of New York-Presbyterian Hospital/Columbia University Medical Center.

He led the surgery in New York that detached and removed a woman's gall bladder through her vagina. The team also inserted laparoscopic instruments into two small incisions in her abdomen, using one instrument to hold tissue out of the way.

A week after that surgery was announced, a French doctor said his team had removed a woman's gall bladder through her vagina without any abdominal incisions. Instead, the team pierced her abdomen with a needle about a tenth of an inch wide. The needle was equipped with a video camera system and also allowed doctors to inflate the abdomen to create a working space.

The surgery, performed April 2 on a 30-year-old woman at University Hospital of Strasbourg, was led by Dr. Jacques Marescaux of the Institute for Research into Cancer of the Digestive System in Strasbourg. In a written statement, Marescaux said the procedure left no abdominal scar.

Meanwhile, surgeons have shown increasing interest in removing brain tumors through the nose over the last five years or so, noted Dr. Gail Rosseau, chief of surgery at the Neurologic-Orthopedic Institute of Chicago.

"This is the dawn of this phase of neurosurgery," said Rosseau, a spokeswoman for the American Association of Neurological Surgeons. "This is exciting, it's new and it may well be better for our patients. In fact, we hope it will be. But it does raise questions."

Cancers can come back if they're not completely removed, she noted. It's too soon to tell whether attacking tumors through the nose leads to a higher rate of cancer recurrence than going through the skull, she said. Concerns like the risk of meningitis from spinal fluid leakage also have to be addressed.

Today, most surgeons would go through the skull to remove baseball-sized tumors, she said, "but a decade from now? I don't know."