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Read Original Story

Gallbladder removed through mouth in new surgical technique

Rating

1 Star

Gallbladder removed through mouth in new surgical technique

Our Review Summary

This is what old news hands used to call a "Hey, Martha!" story, meaning that when someone reads it they will say, "Hey, Martha! Can you believe this?" As such, it makes sense for a news outlet to write about it, but at least some care should be taken to put this experimental procedure into the proper context. Even short items written as blog posts should be well reported, especially from a news organization as large and as influential as the Los Angeles Times.

 

Why This Matters

There is this assumption that minimally invasive surgeries are better simply because they require less cutting. In some cases this is true, but stories about minimally invasive techniques need to provide the evidence that they improve patient outcomes and that they are better than alternatives to surgery.This same type of thing happens among consumer electronics reporters. Smaller is always better. Except, who wants to listen to John Adams’ Century Rolls on ear buds that provide the sonic range of a toaster oven? And who wants to watch Avatar on a screen the size of a credit card? Fewer holes in the body doesn’t necessarily equate to better health outcomes.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

There is no mention of costs. Finding out how much it would cost to remove someone’s gallbladder through laparoscopy would take a call or two. Finding out how much this new equipment might cost would take a few more calls. The researchers behind the study probably know all the relevant costs because they had to secure funding and find the right equipment. Even a noncommital quote from one of the researchers about whether this would add significantly to the cost of gallbladder surgery would be preferable. One of the stated aims of the study is to compare costs between this new technique and laparoscopy, so there could be some preliminary information to be had.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

 There is no quantification of benefits. Instead, we have hope. "The hope is that natural orifice procedures will reduce the risk of infection and pain as well as abdominal scars." Did even this one gallbladder surgery do that? "The center also performed the first oral appendix removal." And how did that go? Was it an improvement? Other questions to ask would be: Why is this information being released now? How many people are in the study? How long before they publish? How much more research would be required before this procedure was available in most hosptials nationwide? None of these questions are addressed. All of them could be in a paragraph or two.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

There is no mention of any harm that might be done by the procedure itself or by opting for this uNPRoven technique over proven alternatives. How effective is gallbladder surgery right now? In the case of cancerous tumors in the gallbladder, does it have a 90% cure rate? 50%? If you were to try to remove a cancerous gallbladder and some of the surrounding tissue with this new technique, could you be as effective? No new approach is without risk especially during the early stages of development.  By definition, NOTES requires a new set of skills on the part of the surgeon making the most experienced practitioner less adept until a sufficient experience is reached.  An open appendectomy is straightforward, whereas a laparoscopic appendectomy requires the surgeon to learn how to use a new set of instruments and view the surgery on a television screen.  NOTES requires the surgeon now be proficient with an endoscope as well. 

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story says nothing about the quality of the evidence. It does, however, make broad statements such as, in referring to laparoscopy, "that type of surgery is a big improvement upon the long, open incisions that patients used to require." Is that true in all cases? Is laparoscopy always the better option? Then the story goes on to say, "However, NOTES spares patients even the tiny abdominal incisions." This presents the surgery as yet another big advance without providing any other information about, among other things, the length of time required under anesthesia for this type of procedure, what has to be done to prep someone for this type of surgery, and the degree of accuracy afforded by this technique versus others. Then the story goes on to say that they’re actually still cutting into people: "In the recent surgery, lead investigator Santiago Horgan made two tiny incisions (not requiring stitches) to pass a camera into the abdomen to increase visibility. However, the gallbladder was removed by way of the mouth." Huh?

Does the story commit disease-mongering?

Not Applicable

To monger a disease, one has to mention the disease. There is nothing in the story indicating why one would have one’s gallbladder removed. So we judge this not applicable.  The press release says, "Cholecystectomy or gallbladder removal is one of the most common surgeries in the U.S.; approximately 750,000 are performed annually."

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

There are no independent sources in this story and no conflicts of interest noted.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

It does make this comparison but only in the most superficial way. Here are three studies from the Cochrane Library that cast doubt on the idea that minimal is always better:

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004751/frame.html
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005344/frame.html
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001785/frame.html

Every time someone wants to write one of these "minimal is better" stories, they should have to read a few of these reviews (and there are many more.) If they saw findings such as this one, they might think twice. "The review showed that laparoscopic repair takes longer and has a more serious complication rate in respect of visceral (especially bladder) and vascular injuries, but recovery is quicker with less persisting pain and numbness." "The complication rate is higher but your recovery time will be quicker," the doctor says. "I’ll go for the old fashioned approach, thank you very much."

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

 The story suggests that UC San Diego is perhaps the only center conducting research into NOTES.  The reality is that while the approach is experimental and not widely available, many academic medical centers are moving in the same direction. In fact the research noted in the story is a multicenter study involving other medical centers.  Although the story meets the requirements for this criterion, some additional information about the increasing interest at other centers would have been useful.

Does the story establish the true novelty of the approach?

Not Satisfactory

Again, the "trend" is alluded to but never explored.

Does the story appear to rely solely or largely on a news release?

Not Satisfactory

This reads as if the release arrived, was hastily re-written and posted on the Web a few minutes later. It went up at 6 a.m. this morning, just as the news release was being sent out. The story at least attributes a comment from one of the researchers to the press release.
http://www.prnewswire.com/news-releases/noscar-announces-first-notes-transoral-and-transvaginal-gallbladder-removals-performed-as-part-of-us-multicenter-human-trial-97951379.html

We pity the writer in these circumstances if she is only afforded 257 words to tell this story.

Total Score: 1 of 9 Satisfactory

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