First Hernia Repair Performed Through the Vagina

In what is believed to be the world's first hernia repair conducted through one of the body's natural openings, surgeons were able to repair a hernia using the vagina as the path to the surgical site.

Surgeons at the University of California (UC) San Diego Medical Center (USA) performed the Natural Orifice Translumenal Endoscopic Surgery (NOTES) procedure as part of an ongoing clinical trial. The hernia repair itself was performed by entering the vagina and then creating an access site via a small incision behind the uterus, through which the abdominal cavity could be accessed with surgical tools and an endoscope. In contrast with a traditional laparoscopic repair, which requires three external incisions, only one small external incision was needed to place an additional camera to safely view the surgical procedure. The two-hour clinical trial surgery was performed under general anesthesia, and the patient returned to normal activities after two days.

"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 minimally invasive surgeon Garth Jacobsen, M.D, one of the surgeons who performed the NOTES surgery under the direction of Santiago Horgan, M.D., director of the UC San Diego Center for the Future of Surgery. "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 [we] will know the full range of possibilities that are most safe and effective for patients.”

"This minimally invasive hernia repair is believed to be the first of its kind in the U.S. and abroad,” added Dr. Horgan. "If research proves that this 'natural orifice' technique is ideal for patients, more than 50,000 women in the U.S. may be eligible for this innovative hernia surgery.”

The surgeons at UC San Diego Medical Center have so far performed 38 NOTES procedures on patient with diseased gallbladders and appendix that were removed through either the mouth or vagina, as well as a previous gastrectomy and the recent hernia repair, all part of a clinical trial comparing ‘scarless' to laparoscopic techniques.

Related Links:
University of California San Diego Medical Center