A new innovation in the medical field is eliminating the jagged traces of scars today. It may be hard to imagine, but you have to envision the possibility of being cut open with scarcely an imprint. It will change the way many patients feel about particularly invasive surgeries as well as the long-lasting bodily scars as a result of these operations.
It has been common medical practice that, since access to the abdominal cavity is required for the surgical treatment and diagnosis of diseases affecting the abdominal organs, traditional methods have involved incision of the abdominal wall, which is often the source of complications such as infection, scarring and pain. Then came laparoscopic surgery (also known as minimally invasive surgery - MIS, Band-Aid surgery, or keyhole surgery), which required smaller incisions. This technique reduced such incision-related complications, but did not entirely eliminate them.
It may sound like science fiction, but the possibility of surgery that can be completed without a scar may soon be a reality. It is known as NOTES, short for Natural Orifice Transluminal Endoscopic Surgery.
NOTES is an experimental surgical technique whereby ‘scarless’ abdominal operations can be performed with an endoscope (an instrument inserted directly into the organ, used to examine the interior of a hollow organ or cavity of the body) introduced through a natural orifice then through an internal incision in the stomach, vagina, bladder or colon, thus avoiding any external incisions or scars. Hence the name; ‘Natural orifice’ means the urethra, the anus, or the mouth. ‘Transluminal’ means surgeons insert surgical tools (endoscopic) through the body's natural openings. And ‘surgery’ implies doctors still have to cut through to the inside of the body in order to operate on diseased organs.
NOTES represents the next phase of minimally invasive surgery, and early clinical experience shows that intra-abdominal surgery using flexible endoscopes is indeed possible, and it avoids any external incisions or scars. Therefore, surgery without scalpels is no longer a fantasy. Rather, NOTES is soon to be a reality for patients everywhere and by eliminating big incisions (and scars) post-surgical recovery can also speed up.
If you look back at the early days of laparoscopic surgery there was an increased rate of specific complications, which threatened to discredit the technique. As a result, and over subsequent years, extensive research regarding safety measures was conducted. Today, laparoscopy is a mature technique and it’s also the standard procedure for most general surgical, gynaecologic, and urologic procedures.
NOTES has taken laparoscopy a step further and rather than being a revolutionary technique, it represents the next greatest surgical evolution. But, other factors must be taken into consideration too. The public at large may be enchanted with the notion of no-scar surgery, but physicians and surgeons should make rational decisions based on minimizing possible complications.
What the NOTES debate has caused in is a renewed interest in finding a way to minimize bodily trauma. Improved cosmesis is an obvious additional psychological advantage for patients, not to mention the benefits in for healing. We may be a long way from routine clinical applications of NOTES, but we are making steady progress. I can envisage a time when removing someone’s gallbladder from the opening of the stomach becomes routine, but that time is not now. Patient safety is paramount, and that must be guaranteed before we determine whether NOTES is the way of the future.
