This illustration was created for an article by Rita Rubin in USA Today entitled “Natural orifice’ surgery has tongues wagging.”

Surgeon Lee Swanstrom of the Oregon Clinic removed a patient’s gallbladder through her mouth. Here’s how:

1. An endoscope was snaked through the patient’s esophagus and into her stomach.

2. Next, a tiny knife was inserted through the scope and cut a quarter-inch to three-eighths-inch hole in her stomach. He then passed a tiny balloon through the scope and inflated it when it got to the end, stretching the hole.*

3. The surgeon dissected the patient’s gallbladder and pulled it back through her stomach and out her esophagus. (At 4 or 5 inches long, it was too large to bring through the scope and out of her mouth in one piece.)

4. Finally, the hole was closed in the patient’s stomach with sutures.

* Note: The surgeon also made two tiny incisions in her abdomen through which he could monitor what was going on. The goal, though, is surgery with no abdominal incisions.

Source: USA TODAY research

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