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A New MGMC procedure removes the gallbladder through the navel, reducing surgery and recovery times.

While on a family vacation in the Caribbean, Natalie Coubrough and her niece passed on the zip line excursion. 

Fear wasn't the factor. Her niece was pregnant, but Coubrough had another reason to opt out of the thrilling ride down a suspended wire.

"It was a great trip and the only thing I didn't do that just about everyone else did was the zip line," she says. "I thought it probably wasn't a good idea to be hanging from a zip line since I'd just had my gallbladder removed."

That pesky little organ nearly derailed Coubrough's much-anticipated Caribbean cruise. But she made the trip, thanks to a new surgical procedure now available through Mary Greeley Medical Center's Surgical Services.

The procedure, called SILSTM, involves a single-incision gallbladder removal, or laparoscopic cholecystectomy. It enables the gallbladder to be removed through the navel. SILSTM usually takes less than hour, and patients can often be home a few hours after surgery.

Dr. James Partridge, a board-certified surgeon, introduced the procedure at a good time. Gallbladder problems usually hit people in their 40s, 50s and 60s. As baby boomers (and, in some cases, their kids) age, gallbladder issues have become more common. Coubrough was the first patient at the medical center-and in the state of Iowa-to undergo the new SILSTM procedure.

Her surgery was in early spring. Since then at least 50 people have undergone the procedure at Mary Greeley Medical Center, says James Partridge, M.D., who did Coubrough's surgery.

"SILSTM is an evolution of minimally invasive surgery that allows us to make fewer incisions and therefore cause less trauma to the abdominal wall," says Partridge. "Patients don't have scars all over and the recovery time is shorter-a matter of days instead of weeks."

Approximately 500,000 procedures are performed each year in the U.S. to remove the gallbladder, a small pear-shaped organ located in the upper abdomen beneath the liver. It stores bile produced by the liver and releases it for digestion. Despite that important role, the gallbladder isn't essential.

A Novel Approach

Gallbladder problems come in three ways: gallstones, inflammation, or gallbladder dysfunction, which Coubrough had. To determine whether the gallbladder is unable to effectively eject bile, a tracer is introduced into the body intravenously.

The tracer fills up the gallbladder. A hormone is then introduced that induces the gallbladder to squeeze and eject whatever it has absorbed. It should eject at least 35 percent of absorbed tracer; otherwise the organ is deemed dysfunctional.

"Dysfunction is unusual, but when you find it, you can expect people to feel better when the organ is removed," says Partridge.

The SILSTM procedure requires an incision about an inch long through or barely under the naval. A spongy blue device is inserted through the incision. It serves as a soft surface for a port, through which the abdominal cavity can be inflated with carbon dioxide. Small tubes, called trocars, which act as tunnels for a tiny camera and instruments, also go through the port.

Partridge also inserts a needle through the abdominal wall, through the gallbladder and then back out the abdomen.

"This acts like a third hand for me, holding up the gallbladder so I can see the length of it, instead of it laying flat against the bowel," he explains.

The camera allows Partridge to observe the suspended gallbladder, determine its anatomy and carefully detach it from the liver. The process needs to be as bloodless as possible to ensure clear visibility. The detached gallbladder is removed through the port.

A Medical Discovery

Coubrough had no idea this surgical method was available back in May when she started experiencing back pain.

"I was having pain in my back, on the right side. It lasted about 12 hours," says Coubrough. "Being a nurse, I started thinking it was likely my gallbladder."

An ultrasound confirmed her suspicion. Coubrough was going to need surgery, but her Caribbean trip was fast approaching.

"I probably could have lived with it for a while but I didn't want to be sick in Puerto Rico and have to go the hospital there to get it taken out," she says.

Her other concern was having surgery and then a lengthy recovery time, which would not only interrupt the trip but her professional life. She's a registered nurse at an outpatient surgery center in Des Moines.

Being relatively new to Ames, Coubrough asked a medical equipment representative to recommend a good surgeon. The representative suggested Partridge, though Coubrough wasn't aware that the medical center's surgeon performed the SILSTM procedure.

"I'd never heard of the single incision procedure so I did a little research on the Internet," says Coubrough. "I was impressed with the new medical technology that I didn't know anything about."

"I got very good care," she adds. "And I know all about that. It's very important to an outpatient surgery center."

The SILSTM procedure also can be performed in gynecologic, bariatric and urologic procedures.

"The right spleen patient's out there somewhere," says Partridge. "I'm looking forward to doing a spleen this way. It should be pretty slick."

Of course, a surgical procedure that involves the navel begs the question: Does it matter if you have an inny or an outy? The answer: No. As a matter of fact, since an outy is the result of a hernia, SILSTM would likely correct it, leaving you with an inny.