Breaking new ground in what many surgeons consider the next frontier in minimally invasive surgery, Yale School of Medicine and Yale-New Haven Hospital surgeon Kurt Roberts, M.D., successfully performed an appendectomy with no abdominal incision. The appendix was removed through a small incision in the patient's vagina.

This advanced technique, known as an "invisible incision" appendectomy, left the patient with no external scar, no damage to the abdominal wall and minimal postoperative pain, thereby allowing for an almost immediate return to normal activity.

"Without incisions in the abdomen, there is no opportunity to develop surgery-related hernias or wound infections. Patients who undergo procedures such as these are expected to recover and resume most normal activities within just a few days," explained Roberts.

Roberts, an assistant professor of surgery at Yale, said there are some reports of this surgery being successfully performed outside of the United States but that previous attempts within the U.S. always necessitated at least one abdominal incision to either help remove the appendix or insert a camera to guide the surgery.

The operation performed by Roberts is the latest advance in a growing surgical field called Natural Orifice Transluminal Endoscopic Surgery (NOTES), in which surgery is performed through the body's natural openings such as the vagina. This approach is becoming increasingly popular because it is even less invasive than traditional laparoscopic surgery, which still requires an abdominal incision.

Because of the ease of recovery and low risk of complications, Robert Udelsman, M.D., chief of the Yale School of Medicine Department of Surgery, said invisible incision is the next wave in minimally invasive surgery. “There may be wide applications for the removal of other organs, including the gallbladder, ovaries and fallopian tubes. This and other minimally invasive approaches result in kinder, gentler surgery."

"Unfortunately," Udelsman said, "there is not a comparable approach for men, at least for the appendix. One could insert a telescope through the mouth and stomach and make a small incision to reach the abdominal cavity and appendix. But this would violate the gastrointestinal tract, increasing the risk of complications." He added, "The ultimate goal with every surgical procedure is the safety of the patient."