Yale Medical Group surgeon Kurt Roberts, MD, performed what he believes to be the world’s first transvaginal ventral hernia repair with no incision in the United States on May 30, and a second one on August 12. The patients, both women, tolerated the procedure very well and had no complications.
A ventral hernia is a defect in the strength of the abdominal wall that Dr. Roberts compares to a hole in tire that can be repaired by fixating a small mesh patch to the abdominal wall. While other surgeons have performed similar procedures that involved making small incisions in the abdomen, he used standard instruments to perform a “pure” procedure through the vagina.
“Doing the surgery without incisions is not just reinventing the wheel. It is really new, absolutely nobody has done it before,” Dr. Roberts says. “The reason we want to do it this way is that it’s a safe operation, and patients go home with no scars on the belly and with very little pain. Their ability to quickly return to normal activities after surgery is remarkable.”
Pioneer in surgery without scars
Dr. Roberts became a pioneer in surgery without scars when he successfully performed the first transvaginal appendectomy without incisions in August 2008. The basic procedure, called Natural Orifice Translumenal Endoscopic Surgery (NOTES), involves passing surgical instruments and a tiny camera through a natural orifice, such as the stomach or the vagina. Dr. Roberts has since performed 58 transvaginal cases, extending the technique to appendectomies and removal of gallbladders.
He is still the only surgeon in Connecticut and one of at least ten in the country performing NOTES surgery, which he expects will become more common as physicians and patients begin to learn about it. “From an evolutionary point of view, we’re the first ones doing it. The next phase is early adopters and late adopters,” says Dr. Roberts, who is teaching the technique to other surgeons. He says about 60 percent of the patients he recommends the procedure to opt to have it. Some heard about it from friends and relatives, and others have read about his work on the internet and sought him out.
Advantages for patients
By avoiding major incisions through the skin, muscle and nerves of the abdomen—incisions that usually limit movement and lifting after an operation—these patients have a significantly reduced risk of post-operative complications such as wound infections, he says. The surgeon bypasses the uterus, so child bearing is not affected. He typically does the surgeries on a Thursday or Friday, so the patient can take the weekend off and go back to work on Monday.
While there are many advantages to the operation, Dr. Roberts says one downside, ironically, is that doctors in emergency rooms can no longer look at a patient’s stomach to see what type of operation they’ve had. One patient told him a doctor didn’t believe she’d had her gall bladder removed and insisted on doing an ultrasound. When he confirmed she didn’t have it, she said, “I told you.”