Apr 09,2024
Mumbai: After suffering from lower abdominal pain for the last two months, 32-year-old Nashik resident Dhrusti Bhonsale (pictured) got her inflamed appendix removed in a novel way: from her mouth.
Doctors from state-run JJ Hospital didn’t make a single external cut while operating on Bhonsale on April 1, successfully using the NOTES technique for the first time.
NOTES stands for natural orifice transluminal endosurgery, in which doctors use natural orifices to perform procedures. Endoscopy is usually a diagnostic procedure used to look inside the body. But since 2008, surgeons have developed a way to use it as a surgical tool.
And, while doctors perform appendectomy using laparoscopy, Bhonsale was very clear that she didn’t want another surgical cut after undergoing two C-sections. “So, our doctors decided to spare her even the tiny cuts of laparoscopy by using NOTES,” said JJ Hospital dean Dr Pallavi Saple.
The surgery team led by Dr Ajay Bhandarwar has previously removed thyroid growth through armpits to avoid surgical scars. “The patient was initially disappointed to hear that even a laparoscopic surgery would have post-operative scars, and asked us for a scarless surgery,” said Dr Bhandarwar.
Dr Shirish Bhagwat said there is an ongoing debate over the benefits of NOTES over laparoscopy and robotics. “For the patient, the biggest advantage with NOTES is the lack of external cuts that ensures fast healing,” he said.
Doctors use an endoscope to reach the stomach, then use special equipment to cut through it into the abdominal space. “The appendix is cut and then brought out using the scope,” said Dr Amol Wagh, a member of the team that performed NOTES on Bhonsale.
However, the procedure has a steep learning curve, said Dr Bhandarwar. “Moreover, it needs special equipment that add to the costs.” He said the technique could become a gamechanger scarless surgery once instrumentation and ergonomics improve.
Bhonsale said her pain began two months ago with nausea. She went to a Nashik hospital, which referred her to JJ Hospital. While she was initially managed conservatively with medication, doctors had to operate on her as the pain worsened. Bhonsale, who was discharged on Monday, said she has been feeling well for the last few days. “After the months of pain, I am relieved and have no scars either.”
Source: Healthworld