- The Washington Times - Sunday, April 29, 2007

PITTSBURGH (AP) - 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.

It’s a startling concept and unpleasant to contemplate, but researchers are exploring new ways to perform 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. 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. Deep inside the body, where tissue doesn’t feel lasting pain, the procedures might be less traumatic.

Some abdominal surgeries such as 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,” Dr. Rattner said. “It’s not trivial, but it also isn’t disabling.”

Sometimes doctors 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. This operation usually would have been done through the mouth.

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.

Dr. Gail Rosseau, chief of surgery at the Neurologic-Orthopedic Institute of Chicago and a spokeswoman for the American Association of Neurological Surgeons, said this is the “dawn of this phase of neurosurgery.”

“This is exciting, it’s new and it may well be better for our patients. In fact, we hope it will be.”

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