Fast Forward : Catching Up With 1990’s Newsmakers : Health: Doctors continue to break new ground using ‘keyhole’ surgery.

Surgeons continued to outdo each other this year by dreaming up new ways to perform major surgery with less time, money and blood involved.

In July, doctors in St. Louis set the standard by performing the first successful removal of a critical organ--a kidney--through a half-inch incision.

Surgeons at Barnes Hospital said they used five punctures--in contrast to a seven-inch incision usually required--to insert instruments into the abdomen of an 85-year-old woman with renal cancer during the not-so-new procedure known as “keyhole” or minimally invasive surgery.

But the removal of a solid organ presented a special challenge.

Gallbladders can be removed through tiny incisions because they can be drained of fluid, then pulled out like a collapsed balloon. But kidneys are solid organs that have to be disintegrated inside the body before they can be removed, according to Dr. Ralph V. Clayman, who directed the kidney surgery.

To do this, doctors used a viewing device called a laparoscope inserted in one opening while tubes and instruments were placed in the other openings.

Doctors developed a technique in which the kidney was detached and then placed in a nylon bag, all inside the abdomen. Next, doctors pulled the bag’s drawstrings and neck through one of the tubes and inserted an electric morcellator--an instrument that fragments the detached organ.

After grinding the organ inside the leakproof bag, the contents were sucked out through the tube and the bag was removed.

Doctors reported that the patient needed only one dose of pain medication and was drinking fluids within 36 hours. Patients usually don’t eat for days after standard kidney removal. The woman was hospitalized for six days and was back to her normal routine in 10.

Keyhole surgery has been used for at least a decade for specific procedures such as repairing knee ligaments, particularly among athletes who don’t want to take the time for major surgery and a long-term recovery. During the past year, use of the procedure to remove gallbladders has become enormously popular. But the removal of a kidney takes the technology one step beyond that, experts say.

Of course, there aren’t many organs you would want to lose, much less have morcellated.

But, said Clayman: “This surgery shows the possibilities of what can be done.”