PORTLAND, Ore. – A surgeon has performed the country’s first operation to remove a patient’s gallbladder through her mouth.

Operating on a 35-year-old woman, Dr. Lee Swanstrom threaded tiny instruments through her mouth, down her esophagus and into her stomach. Using special endoscopic tools that contain a camera, the surgeon cut a hole in her stomach to reach the gallbladder, which is attached to the liver.

Then he cut away the diseased gallbladder and pulled it through the incision in the stomach, up her throat and out her mouth.

Swanstrom, who performed the surgery May 31 at Legacy Good Samaritan Hospital and Medical Center, said it heralds a new way of doing many kinds of abdominal surgeries without external incisions. He said the surgery has been performed in Brazil but this was the first time in the United States.

Swanstrom is part of a group of doctors and medical device manufacturers nationwide working to develop “natural orifice” surgeries – through the mouth, vagina and rectum – to help eliminate pain and scarring and reduce recovery time. Swanstrom says within 10 years gallbladder surgery, using this method, might be done in a doctor’s office rather than an operating room.

Swanstrom’s procedure follows one in April by another team of surgeons in New York where a woman’s gallbladder was taken out through her vagina. He applauded that effort but added, “Since only half the population has vaginas we were looking for a more universal platform.”

Swanstrom said he has performed three of the new surgeries so far, all on women, and the patients have fully recovered. He plans to do 22 more as part of a research project and then evaluate the results.

“It’s a very technically demanding procedure because it involves flexible endoscopy and surgery,” he said.

In the past decade, surgeons have developed less invasive ways to remove troublesome gallbladders, which normally hold bile that aids digestion. The organs need to be removed when they become diseased or fill with crystalline masses, or gallstones.

About 95 percent of gallbladder surgery is done by a technique called laparoscopy, in which the surgeon manipulates surgical instruments and a miniature video camera inserted through tiny incisions in the abdomen. The surgery may require an overnight stay in the hospital.

A technique called “open” surgery is used in the other 5 percent of gallbladder operations, when infection or scarring prevents laparoscopy. Open surgery makes a 5- to 8-inch incision in the abdomen to remove the gallbladder and requires a two- to seven-day stay in the hospital and several more weeks at home to recover.

Swanstrom’s new procedure is intended to eliminate abdominal incisions altogether and get patients back to normal in a day or so.

But patients in the research program won’t reap the full benefit. Swanstrom said they will have abdominal incisions to allow observers to watch the procedure through a camera inserted inside the body. The incisions also allow the insertion of small surgical instruments as an additional safety measure.

The incision made inside the stomach to reach the gallbladder is so small – about ¾ of an inch – that it is virtually painless, Swanstrom said. No special dietary requirements are necessary; patients can eat normally as soon as they wish.

LeAnne Platt, 46, of Hillsboro, Ore., underwent the surgery Saturday.

“I didn’t eat anything on Sunday,” she said. “Nothing tasted good anyway – it was probably because of the anesthesia.”

But Tuesday, Platt said, she ate a dinner of fish with a panko coating and some asparagus. On Wednesday evening, she had chicken.

Some medical experts are optimistic about the new surgery.

“This is a pioneering procedure that holds a lot of promise,” said Dr. Brant K. Oelschlager, a specialist in minimally invasive surgery at the University of Washington Medical Center in Seattle.

Natural orifice surgery “is a hot topic at all the surgical conferences, and while there are skeptics, there are those of us who think that this kind of surgery is going to be a positive step for patient care,” Oelschlager said.

The research program is financed in part by three equipment manufacturers – USGI Medical, Boston Scientific and Olympus – as well as by the Division of Minimally Invasive Surgery at Legacy.

Gallbladder surgery is the most common major surgical operation in the United States. Each year, more than 500,000 Americans have gallbladder surgery, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Removal of the gallbladder is called cholecystectomy.