First minimally invasive hernia repair through vagina
November 2008
Surgeons at the University of California (UC) San Diego Medical
Center have reported what is believed to be the world’s first hernia
repair conducted through one of the body’s natural openings. As part of
a clinical trial, minimally invasive surgeons Garth Jacobsen, MD, and
Santiago Horgan, MD, were able to repair a painful weak spot in a
patient’s abdominal wall using the vagina as the path to the surgical
site.
The process of performing surgery through a natural opening is known
as Natural Orifice Translumenal Endoscopic Surgery or NOTES. By avoiding
major incisions through the abdomen, patients may experience a quicker
recovery with less pain and scarring.
“This minimally invasive hernia repair is believed to be the first of
its kind in the US and abroad,” said Horgan, director of the UC San
Diego Center for the Future of Surgery. “If research proves that this
‘natural orifice’ technique is ideal for patients, more than 50,000
women in the US may be eligible for this innovative hernia surgery.”
“I now feel good. I feel strong. The difference between this surgery
and my previous hernia repair is night and day. I feel fantastic,” said
the patient, 38 year-old Leah Kent of Torrey Highlands, San Diego.
A hernia is an abnormal bulging of organs or fatty tissue through a
muscular wall. The bulge is repaired by closing the hole with stitches
and then placing a mesh over the repair for reinforcement. The mesh is
made up of a biologic absorbable material and over time is incorporated
into the body’s tissue.
This repair itself was performed by entering the vagina and making a
small incision behind the uterus through which the abdomen could be
accessed with surgical tools. Only one small external incision was made
to place a camera to safely view the surgery. A traditional laparoscopic
repair uses three incisions.
Kent, who believes that her hernia developed as a result of genetics
and pregnancy, says that her family members have had hernia repair. She
also recently gave birth to her fifth child.
“The hernia was apparent by looking at my stomach. There was a bump
there that was visible through my shirt and internally painful,” said
Kent. “I was interested in this option because I wanted anything with
less scarring. I previously had a hernia repair that left a 4 inch
zig-zag scar across my belly button and I was always aware of the
material used to perform the repair. I did not want the same again.”
The two-hour clinical trial surgery was performed under general
anesthesia. After two days the patient returned to normal activities.
“The UC San Diego Center for the Future of Surgery is testing new
techniques designed to minimize or eliminate incisions through the
abdominal wall,” said Jacobsen. “What we are seeing is that the vagina
is a route that heals very quickly. This technique also looks
particularly promising for surgeries to treat obesity such as gastric
banding and partial stomach removal. Only through testing will know the
full range of possibilities that are most safe and effective for
patients.”
Surgeons at UC San Diego Medical Center have performed 38 of these
natural orifice surgeries as part of a clinical trial comparing
“scarless” to laparoscopic techniques. Patients recruited to the trial
have had diseased gallbladders and appendix removed through either the
mouth or vagina. A gastrectomy, an obesity surgery that reduces the size
of the stomach, and the hernia repair, are also part of the clinical
trial.
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