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First of all, this is still a laparoscopic operation.
The abdominal wall near the umbilicus has loads of really tough layers which need to be cut through, and healing the rectus muscles and the like takes quite a long time. On the other hand, in males there's the scrotum - a nice, thin layer with
a weak point already there through which laparoscopic surgery can be performed just as easily once the incision has been made. Make an incision like the one used for a vasectomy, shove keyhole instruments through it, bypassing the tunica vaginalis, go up the inguinal canal into the peritoneal cavity, snip off the appendix and pull it out through the scrotum. The groin is closer to the appendix than the umbilicus and even closer after insufflation of the peritoneum, which could also be done via the scrotum. Whereas there clearly is a risk of peritonitis from the bladder, that risk exists in any case from the colon and faecal peritonitis and the fact that in any case the pus goes everywhere and the whole area has to be irrigated anyway.
Also useful for other surgery near the groin.
Kidney transplants for girls.
http://news.bbc.co..../health/7867837.stm
[AbsintheWithoutLeave, Apr 04 2009]
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how does this work with girls? I sometimes wonder if you guys forget that we exist... this place wouldn't without a girl... |
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Having undergone an appendectomy just over a year ago, I can confirm that I'd've been happy if they'd removed it via trepanning if it would've stopped the pain any quicker. |
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Po, that women exist doesn't mean that one can't use male anatomical specifics to make life easier for about half the world's population. I don't see a problem with that. |
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Thanks for the support, [Jutta]. This actually came out of a conversation about women's pelvic cavities being open to the outside. Looking at the link, it looks like there are advantages to having a vagina. I also thought about the Fallopian tubes, but it seems a bit of a tall order to get an appendix out via one of those and the cervix. [Po], i'll try to think of a bit of surgery involving female reproductive systems.
[21_Quest] and [Absinthe], i'm sure i'd want it out ASAP via any route, but would you not also prefer a quicker recovery, less risk of infection and a smaller scar?
Now going off to think of a good transvaginal op, though the kidney thing seems difficult to follow. |
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[21 quest] I've had both appendectomy and vasectomy; for the former I was out cold (and happy to be so), for the latter, the most embarassing part was having to ask the surgeon for permission to fart.
[19thly] the scar is smaller than a C-section scar (seen the whole process), I was out of hospital in less than two days, back at work and driving in 14 days, no infection. Keyhole is fine if the condition is diagnosed in time, but mine was an emergency; if I'd spent much longer in A&E, I'd've tried seppuku to relieve the pain.
//it looks like there are advantages to having a vagina// [marked-for-tagline] |
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But it's so convenient. You can even palpate bits of bowel through it if you need to. Also, from the outside it'd be like a one-sided vasectomy scar. Someone who's happy to have a vasectomy would probably be equally comfortable with an appendix out through there. I can't say i have any conceptual problem with it myself.
OK, [po], well it looks like if you can remove a kidney through the vagina, you could do the same with the appendix. I think it probably has similar advantages, except that it wouldn't leave any external scar at all. Come to think of it, in a way the pouch between the vagina and the rectum would be better than the scrotum. You could go through there instead and get at basically the same bits, though i don't know if you'd be starting from the same distance in. You'd also have no visible scar at all.
So, that would be (for men) prostate operations, for both sexes bowel resection, appendectomy and maybe you could even get a kidney out via the scrotum too. |
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[Absinthe], an emergency is another matter. By the way, botched appendix operations have occasionally led to scrotal abscesses. So, being in a position to compare the two, would you not prefer the vasectomy? Even lower segment CS scars can be quite large and involve distal numbness. |
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//What if you plan to have kids later? I//
I have two teenagers. Give me a break. |
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//being in a position to compare the two, would you not prefer the vasectomy//
My vasectomy scars are (to me) no longer visible (I'm sure to a trained forensic observer, they're like the Grand Canyon)
The appendectomy is somewhat south of the equator, and without the aid of reflective surfaces, all but invisible. |
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choices, choices: whether I want a scar in my abdomen or in my scrotum, gee what a difficult decision... not. [-] |
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<cringes, winces and sucks air through teeth but...(+)> |
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Personally, if my appendix ever needs to be removed, I'll go
private and have it taken out through a hole in someone
else's scrotum. |
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[21_Quest], it isn't an actual vasectomy, it just uses the same point of entry. You leave the OT with two intact vasibus deferentibus. Maybe the problem is that people are used to the concept of things emerging per vaginam, but not per scrotum? The issue is recovery and the risk of infection, and i would say the scar is just a bonus, but you won't have a fibrous adhesion between the cæcum and the wall of the peritoneum this way. |
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You could always use the lithotomy position and go for the appendix that way through the perineum. |
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Depending how much bowel you were taking and whether you needed to visualise cancers on the bowel to ensure you got them all it might be useful for resection. It's been a while so I'm not sure how easy it would be with current techniques to re-connect the severed ends of bowel vis keyhole techniques like this. Back in my day of being involved in this area they needed to uncoil the bowel like the 'flags of all nations' trick and suture them while they were semi-external. A decent resection would leave two good sized scars, front and rear. |
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I think this (or something similar to this i.e. via the perineum) is how Samuel Pepys had his kidney stones removed, without anaesthetic by a 17th century surgeon (there were no other types of surgeon available at the time) |
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Yes, that's why it's called the lithotomy position. It was a less risky operation at the time. The general idea was that almost any surgery on the torso would be fatal (which makes me worry about C-sections because they were done back then), but cutting for the stone involved going from the anus into the bladder or urethra, which meant there was a lower risk of peritonitis. It was still very risky. I don't know much about Pepys, but i would expect the stones to be on their way down by the time he had them out. |
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//how Samuel Pepys had his kidney stones removed//
My eyes are watering just at the thought. |
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Modern surgery is mystifying. A close relative just had heart surgery (which involved stopping the heart, connecting it to an external pump for the duration of the operation and inspecting and then replacing one of the heart valves) *without* opening up the ribcage. |
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In a way, though, the old conditions of surgery would be more suited to the new techniques, as they avoid making huge incisions and can sometimes be done under a local, though i can imagine infection being a huge problem anyway. Maybe we'll go full circle and people will end up having operations at the hairdressers. |
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With Pepys it was bladder stones and the cutting of the bladder in the lithotomy position helps to flush them out. He had his done on the 26th March 1658. The other scary bit of the surgery is that the surgeon starts the procedure by inserting an instrument, the intinerarium, into the urethra to help position the stone. |
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As I understand it the presence of that weak point is why inguinal hernias are so much more common in males than females. |
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How would having this operation affect the risk of getting a hernia later in life? |
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Yes, that's the weak point. However, i did say you'd need to bypass the tunica vaginalis. Some inguinal hernias are to do with a congenital failure of the "hole" through which the testicle descends, others further up on the abdominal wall. The incisions would heal and the risk wouldn't be reduced in the case of the congenital one anyway. I reckon it'd be the same as the risk of an umbilical hernia after keyhole surgery there, and actually probably less so because the linea alba looks to me like it's under more strain than the inguinal region. Incidentally, there's a relatively rare hernia which involves the appendix entering the scrotum, so in that situation this is actually baked.
I wonder also if you could combine this op with hernia repair if the cause is congenital, so you might even reduce the risk of hernia. |
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If my surgeon severed my dorsal penile nerve doing an appendectomy, I would punch him in the mouth. It would actually be much less invasive to do it transvaginally. There is a really, really thin spot in the posterior fornix of the vagina next ot the cervix. |
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Now if you can figure out how to do it with an endoscope... |
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I can see there might be a few men out there who would agree with you there, [GutPunch], so we're left with the irony of a trans-scrotal appendectomy which is better suited to women than men. |
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I wonder if it would be possible to train some small burrowing animal like a mole, to carefully manoeuvre inside an anaesthetised (of course) patient and avoid all other organs; chew out the offending part, returning to the "surface" by coming back out using the same route as it entered.....any volunteers? |
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no but as long as it doesn't crawl into my scrotum you've got my vote. |
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Sounds pretty good to me. I do wonder about the potential for hernias. I'd expect that might be a potential risk. |
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The muscular layers covering the testicles are formed from the abdominal wall, and are known as the tunica vaginalis. This could be bypassed and you could go up the canal down which the hernia usually comes out, known as the inguinal canal, to reach the appendix. The hole cut to reach the appendix would be at a different angle to that at which the intestine moves when it herniates. For this reason, i don't think it's a risk. |
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