World's first no-scar surgery

On April 2, 2007, at the University Hospital of Strasbourg in France, Professor Jacques Marescaux and his team successfully performed the world's first no-scar surgery.

This first human operation without abdominal incisions was carried out using a flexible endoscope for transvaginal removal of the gallbladder (cholecystectomy) in a 30-year-old woman suffering from multiple pain episodes due to gallstones.

This breakthrough surgical procedure, called Operation Anubis, exemplifies the evolution of surgery. The operation consists of gallbladder removal performed without scars on the abdominal wall. Using a flexible endoscope inserted into the abdominal cavity through an incision on the vaginal wall, the gallbladder is removed using an endoscopic retrieval bag. The only "invasion" to the abdominal wall consisted of a 2mm needle equipped with a video camera system. This needle also served for gas insufflation, which is necessary to create a working space within the abdomen and to monitor the intrabdominal pressure throughout the procedure.

The benefits of this technique include: the reduction or absence of post- operative pain, ease of access to some organs; absence of trauma to the abdominal wall; ideal cosmetic results and the psychological advantages of eliminating the bodily trauma resulting from surgery.

"This technique provides proof that there are no limits to how human ingenuity and technology can reduce the physical and emotional trauma related to any surgical act," says Professor Jacques Marescaux, lead surgeon. "The next challenge will be to validate other approaches, with the transgastric route as the most promising procedure."

The successful performance of Operation Anubis at the University Hospital in Strasbourg is the result of three years of research supported by the Therapeutic Innovation Biocluster Center at the Institute for Research into Cancer of the Digestive System (IRCAD) and in collaboration with KARL STORZ, an international leader in endoscopes.

On March 20, 2007, a team of specialists at Columbia University in New York performed a hybrid transvaginal cholecystectomy with the assistance of three laparoscopic trocars (The New York Times, April 20, 2007). While this procedure required the aid of surgical incisions to remove the gallbladder, Operation Anubis was performed entirely through the vagina with one small invasion to the abdomen, which marks a major step forward compared with conventional surgery