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Washington University School of Medicine, Office of Public Affairs, by Caroline Arbanas, posted October 7, 2008

In a first for the St. Louis region, surgeons at Washington University School of Medicine are removing patients' gallbladders using a single small incision in the bellybutton that leaves only a barely visible scar.

"The more than a dozen patients who have had the procedure have fared extremely well," says minimally invasive surgeon L. Michael Brunt, M.D., who performs the surgery at Barnes-Jewish Hospital. "They typically go home the same day as the surgery or the morning afterward. But the most striking difference is that when patients come back several weeks later for a check up, you essentially can't see a scar."

Surgery to remove the gall bladder is one of the most common operations performed in the United States. More than 750,000 patients undergo the procedure each year, often due to the formation of gallstones that cause intense pain. The surgery typically is performed using a laparoscopic technique in which surgical instruments and a miniature video camera are inserted into four small incisions in the abdomen. The camera is linked to a video monitor, where surgeons view the patient's internal organs.

With the new procedure, the long, slender surgical instruments and camera are all inserted through a one-inch incision in the belly button. "This not only minimizes scarring but reduces pain because there are fewer incisions," says Brunt, who is professor of surgery and co-director of the Institute for Minimally Invasive Surgery at the School of Medicine.

The single-incision surgery is more technically challenging than a traditional laparoscopic procedure, says Brent Matthews, M.D., associate professor of surgery and chief of the section of minimally invasive surgery, who also performs the operation at Barnes-Jewish Hospital. But he predicts that the majority of gallbladder surgeries at Barnes-Jewish soon will be performed using this technique.

"One of the biggest advances in surgery over the past 20 years was the development of laparoscopic techniques to perform many operations that were traditionally done through a large, open incision," Matthews says. "Now, we're looking for ways to make those operations even less invasive, and the single-incision bellybutton surgery is one alternative. In the future, I think we'll see a number of different operations besides gallbladder surgery that can be done using this technique."

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