UCSD Surgeons Perform Nation’s First Scarless Surgery

    Surgeons from UCSD
    Medical Center

    were recently the first in the nation to remove a diseased appendix via a
    patient’s mouth and a patient’s vagina, minimizing scars and pain.

    In the procedure, Natural Orifice Translumenal Endoscopic
    Surgery, instruments required to remove diseased organs like the appendix and
    gall bladder are passed through a natural orifice, such as the mouth or the
    vagina. Only a small, two-millimeter incision is required to insert a camera
    into the abdominal cavity.

    Since this type of procedure does not require a large
    external incision through the abdomen, patients will suffer less postoperative
    pain and recover faster.

    A team of surgeons from the UCSD
    for the Future of Surgery —
    including Director Santiago Horgan and Mark A. Talamini, the chair of the
    department of surgery at the medical center — has been performing the technique
    on a trial basis. UCSD’s Institutional Review Board, which is in charge of
    clinical research, has approved this procedure for a limited number of patients
    through what Talamini calls a “rigorous” process.

    “Imagine a day when surgery requires no incisions or just
    one tiny incision that is only millimeters in length,” Talamini said in a
    statement. “Scarless, painless techniques are what the UCSD
    for the Future of Surgery is
    setting the stage for right this minute. Patients deserve it.”

    Horgan, who has performed 14 of these minimally invasive
    surgeries, is also the president of the Minimally Invasive Robotics Association
    and advocates a close partnership with biotechnology companies to develop the
    instruments needed for these advanced procedures.

    Patients are carefully selected for the procedure so
    surgeons can get the best possible results.

    “We have a carefully crafted approved protocol that
    delineates who is a candidate, and who isn’t,” Talamini wrote in an e-mail.
    “Based upon those criteria, we approach patients in our clinics and in the
    emergency department with this new approach as an option. An important aspect
    to this early work is that we can easily and quickly move to the traditional
    approach during the operation if necessary.”

    In the most recent surgery, surgeons removed a diseased
    appendix from Diana Schlamadinger, a third-year doctoral candidate in chemistry
    at UCSD, using the N.O.T.E.S. procedure through her vagina. This was an
    emergency procedure, so Schlamadinger had only two hours before surgery to
    decide whether she should use the N.O.T.E.S. procedure.

    “The surgery appealed to me because the work I do every day
    relates to science research and discovery,” Schlamadinger said. “I understand the
    need for these trials to provide patients new information and new procedures.”

    According to Schlamadinger, the risks of this trial
    procedure are about the same as the traditional method of appendix removal. For
    both, the greatest risk is postoperation infections, which have not troubled

    Overall, Schlamadinger is satisfied with the results. She
    reported her pain as a “one-half to one” on the pain scale, which ranges from
    zero to 10.

    “I had never had a
    surgery before, so I wasn’t sure what kind of pain to expect,” Schlamadinger
    said. “My doctors tell me my recovery has been very fast, however.”

    She said her stomach
    pain abated after four days and she stopped taking painkillers within two days
    of returning from the hospital. Within six days, Schlamadinger returned to

    “I am indeed happy that I had the minimally invasive
    technique because of the speed of the recovery and because of the chance to
    make a difference in medical science,” she said. “Lastly, I am happy to have no
    scars on my stomach, just a tiny incision they made in my belly button for a
    two-millimeter camera.”

    Talamini is confident that the method will become
    increasingly precise.

    “In the future, the tools that are being developed for this
    will also be useful for removing pieces of tissue from inside organs, rather
    than removing whole large segments of organs,” he said in an e-mail.

    UCSD Medical
    has also recently performed
    a first-of-its-kind appendectomy via the mouth. The patient, Jeff Scholz,
    reported a “two” on the pain scale the day after surgery.

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