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Appendix operation through the mouth
Last updated at 11:50am on 16.04.08
Cakehole surgery: patient Jeff Scholz during the procedure
Surgeons have removed a man's appendix through his mouth in a radical world first.
The pioneering operation - dubbed "cakehole surgery" - means no unsightly scars, and the patient was doing sit-ups three days afterwards.
Today, doctors released the first pictures of the bizarre-looking procedure on Jeff Scholz, which was undertaken using miniaturised surgical tools.
It is hoped this new approach could slash waiting times, cut down on infection and reduce post-operative pain.
Doctors say Mr Scholz, 42, an ex-US marine, has made a speedier recovery than he would have done with standard keyhole surgery.
Surgeons at the University of California San Diego Medical Centre threaded tiny instruments, including a camera, down Mr Scholz's throat. After emptying his stomach they cut into its lining to cut away the inflamed appendix. The rogue organ was placed in a bag and pulled back up though Mr Scholz's stomach and throat and out of his mouth.
Amazingly, he was discharged after just 17 hours in hospital and claimed to be back at work the day after.
Mr Scholz said: "I was eating pizza and doing sit-ups three days later. You'd think the way it was done, going through the stomach wall, I'd have stomach pains, but there was nothing."
It is the first time the procedure has been publicly shown, although a team of Indian surgeons claim to have carried out a similar one.
Through-the-mouth surgery is still in the experimental stages, but surgeons are confident their new methods reduce the risk of infections like MRSA.
Centre director Professor Santiago Horgan said: "My dad was a surgeon and back then the larger the incision, the better the surgeon. Today we're moving away from that to minimise trauma. We can improve pain and complications."
Reader views (33)
This is another example of the concept..."just because it can be done, doesn't make it a good idea." There are too many opportunities for internal damage of the likes caused by heart catheterization. In the long term it will become know as a bad idea poorly executed. Sorry but No Thanks.
- Harcourt, Homeland, USA
My guess is that they must have exited the stomach and then snaked the tube down the abdominal cavity to the right lower quadrant and then removed the appendix and then pulled it back into the stomach and on out the mouth. Quite clever if you can avoid puncturing any major vessels on the surface of the stomach.
- Rudy, Pilot Rock, OR
Apparently Rav, they wrote it well.. you just failed to read it well. They said they cut through the lining of the stomach to get to the appendix.
Sometimes it is better to be silent and thought of as ignorant than to open your mouth and remove all doubt.
- Don, Dallas, Texas
Just because you can't see the scars doesn't mean there aren't any. I think this type of operation will grow in population because patients will request it, but then the complications will arise and surgeons will be reluctant to provide this type of treatment.
- Megan, danville, pa, usa
My concern would be if there was any rupture it would be hard to not contaminate the entire abdominal cavity when you pull it out even if it is in a bag. I suppose if it was ruptured you'd have to go in the traditional way anyway.
- Deb, California
The cut in the stomach has to be closed during the surgery or you would get sick. It does not repair itself quickly at all. The appendix is also a bit further than a couple of inches from the stomach as well. As far as the discharge and recovery time, that is similar to laparoscopic surgery. I would also expect infection rates to be higher given the lack of antibiotic prep inside the stomach and the presence of bacteria.
- Mh, Indiana
Former patient, the appendix and stomach are more than a couple of inches away from each other, and there's a lot of small intestine in the way. That would not be practical.
- Md, USA
Rav,
Read it again. They went 'through' the stomach wall to get to the appendix.
- Doug Roberts, Thunder Bay, CA
I just had my appendix remove it left me with a big freaking scar! Bigger than a c-section procedure!
- J, U.S, Miami
They probably sent the tube down his mouth (duh) and then cut a hole in his stomach to access the appendix, then cut it loose and dragged it through that hole and up. How else would they get it out his mouth?
Think for a moment.
- Haha., Canada
Think about this.... I'll bet the fella had a sore throat.
- Jamies48@Yahoo.Com, Hamelk179@Yahoo.Com, Central Coast
Mr Scholz said: "I was eating pizza and doing sit-ups three days later. You'd think the way it was done, going through the stomach wall, I'd have stomach pains, but there was nothing."
The surgery was apparently performed by going through the stomach wall.
- Kyle, New York, USA
Typical of TIL...misplaced their April Fools story until now and ran it any way.
It's obviously a gag story (pun intended).
- Michael, Boston, USA
If only I'd known about this before having my ankle surgery!
- Gordon, Chicago, USA
People may want to Google-image a diagram of the abdomen to quickly see the anatomy. And don't forget: for weird reasons many people call the whole abdomen a stomach instead of just the stomach organ itself. That's why I call the abdomen a belly.
- Doc Ock, Indianapolis, IN
I had my appendix removed in 1964, a senior in high school , and the incision is 3 inches long and looks like I was cut with a coke bottle . Spent a week in the hospital and I was in great shape .
- Rich, USA
There's no way that they could access the appendix from the stomach unless they cut a hole in it and searched around intra-abdominally. Otherwise, they would have traversed some 20 ft. of small intestine before reaching the colon/appendix. Alternatively, one could access the appendix via the anal route.
- Mike Jefferson, Washington, D.C.
You think this is something? Wait until you hear how they plan to take out your tonsils!
- Rufus Carswell, Atlanta, GA, USA
I wish they would have done this to me when I had mine out. I did not care for the pain to any degree, but the inability to go to the bathroom, etc., and not being able to roll over...a real pain. I love progress in medicine. But in through the mouth? There is probably a better way in through the rear end and a lot closer to the sick organ, and there is that "aftertaste" factor to consider if that bag tears.
- Charles T. Sherwin, pittsboro nc usa
It took guts to try that.
- Kenneth, USA
I think this is an amazing story! I have Ulcerative Colitis and I am considering undergoing laproscopic surgery to remove the large intestine. I hope one day they figure out how to remove the large intestine through the mouth. When I first read the headline I thought they travelled through the small intestine to get at it! Absolutely Amazing! I want to see this operation on Discovery Channel.
- Chris, Orlando, FL USA
Big deal. I did the same thing at a bar last Friday night.
- Annie Where-But-Here, Waldo, TX
Of course the appendix is not in the stomach. They go down the throat to the stomach, empty the stomach, then cut a hole in the stomach to get to the appendix. The appendix is removed, then pulled back through the hole, into the stomach so that it can be taken up the oesophagus and out the throat.
- Allison, Chicago, Illinois
It sounds like they accessed the appendix through the stomach wall rather than having to thread instruments through the intestines. Once you are into the abdominal cavity, many organs would be accessible without having to go through the abdominal muscles.
- Thomas, Philadelphia, PA
Cakehole surgery! Superb.
- Peter, New York, USA
This is an experiment on a live human being...not a surgical operation!
- Juan Q. Publique, Middleton, OH, USA
Reminds me of the joke where the Gynecologist went to auto mechanic school.
When he completed the insrtuctor'e assignment of assembling a car engine, he was given the grade of B. He challenged the grade.
The instructor asked him why he deserved an A.
The student replied, "because I did it going through the tailpipe!
- Jp, Streamwood, il
The appendix is at the colon, not the stomach. If one were going to operate through an orifice, it wouldn't be through the mouth!
- George, San Jose, California USA
They probably meant cut through the stomach lining to access the appendix. It is located at the intersection of the small and large intestine but is barely a couple inches away from the stomach for most people.
- Former Patient, USA
This makes sense. The stomach repairs it self very quickly (fast growing cells). I think this will become routine.
- Annie, USA
Who wrote this? The appendix is not in the stomach!
- Rav, Canada
Actually, this is called NOTES surgery (Natural Oriface Trans-Luminal Endoscopic Surgery) not cakehole surgery. The appendix is off the large intestine. The surgeons do make a small hole in the stomach and travel in the abdomen with a camera to reach the appendix. It is removed in a manner similar to a laparoscopic (keyhole?) appendectomy and dragged out through the stomach. The hole in the stomach is then closed. It is "scar-less" surgery and is about 5-10 years from becoming a day to day operation. It is only being performed at highly specialized centres by highly trained endoscopic surgeons. The benefits to this scarless approach are widely debated in the surgical community but the technique has opened by new avenues of surgical technological advances.
- John Scott, Knoxville, TN
I thought that the appendix was in the large intestine, and closer to the other end of the digestive tract? If it was taken from the lining of the stomach, perhaps it was an ulcer. Or maybe they cut right through the stomach lining to get to the appendix? The description of just what was done is rather vague.
- Phil Jones, London UK
