Two weeks of hospitalization and months of recovery before going to gym because of an appendix removal surgery? All these may be gone for women. For the first time in U.S., on March 26, 2008, a team at UC San Diego Medical Center removed an inflamed appendix through a patient's vagina.

The procedure lasted just 50 minutes, and the patient, Diana Schlamadinger, a third-year graduate student at UC San Diego, experienced just minor discomfort. She had classified her pain as a '1' on a scale of 1 to 10.

Using body's natural openings, like mouth or vagina, for removing ill organs, like inflamed appendixes or gallbladders, translates into a short recovery, low pain, and, in a world of image, no scars. This does not mention the lack of more severe risks, like abdominal hernia, following a classical procedure.

Natural Orifice Translumenal Endoscopic Surgery (NOTES) is based on newly-developed minimally-invasive laparoscopic tools. The only surface incision, a tiny cut through the belly button, is used for introducing a two mm camera into the abdominal cavity, which allows the surgeons to access the surgical point, while avoiding organs and blood vessels.

"The path to innovation is dynamic, requiring quick response from the companies developing the tools. Partnership with industry keeps us rolling from one success to another. The evolution of surgery to incisionless techniques is on the horizon," said Dr. Santiago Horgan, director of the UC San Diego Center for the Future of Surgery Horgan and president of the Minimally Invasive Robotics Association. He is a world leader in minimally invasive surgeries, with 14 NOTES procedures performed in the U.S. and Argentina.

"Imagine a day when surgery requires no incisions or just one tiny incision that is only millimeters in length. Scarless, painless techniques are what the UCSD Center for the Future of Surgery is setting the stage for right this minute. Patients deserve it," said Dr. Mark A. Talamini, professor and chairman of the Department of Surgery at UC San Diego Medical Center.

The UC San Diego Medical Center has performed fourth NOTES so far, the first one in September 2007. The team used RealHand High Dexterity tools, developed by Novare Surgical. RealHand tools track the surgeon's hand movements and have been adapted for transvaginal NOTES. The images from inside the body were delivered by a flexible, high-definition digital endoscope made by Olympus America.