New surgical technique holds promise for scarless operations

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Washington, June 3 (ANI): Scientists have made new advances in a technology-called Natural Orifice Translumenal Endoscopic Surgery (NOTES)-that could pave the way for scarless gastroenterology and surgery.

NOTES eliminates the need for incisions and allows for less pain and scarring associated with traditional laparoscopic surgery along with a much faster recovery time for the patient.

The researchers even made videos illustrating the most recent NOTES applications, including cholecystectomy, appendectomy and gastrectomy.

"The potential of NOTES and near-NOTES procedures is being demonstrated. These latest studies show that surgeries that once subjected patients to significant pain and recovery time may become a thing of the past," said Dr. Michael L. Kochman.

NOTES is performed by passing an endoscope through a natural orifice, or opening, then through an internal incision in the stomach, vagina, bladder or colon, thus avoiding any external incisions or scars.

For the first time, NOTES was used for incisionless weight loss surgery known as Transoral Gastroplasty- the novel procedure, aimed at patients in need of intermediate weight loss.

It involves placing a device into the stomach that uses a vacuum to bring the sides of the stomach together and stapling them without the necessity of making incisions in the abdominal wall.

The use of NOTES also showed promise in performing transvaginal sleeve gastrectomy in morbidly obese patients, as researchers at University of California San Diego (UCSD) claimed that the procedure could a far less painful and dangerous surgical weight loss option.

It requires surgeons to make two small incisions in the abdomen and one in the vagina to remove 70 percent of the patient's stomach.

The researchers claimed that appendectomies are the latest, successful use of NOTES, as initial results suggested that transvaginal appendectomy is a promising, emerging technique for acute appendicitis.

In the procedure, surgeons remove the appendix using the vagina as the port of entry to the peritoneal cavity. It requires only two small incisions, one in the abdomen and one in the vagina.

Researchers at Hospital Bocalandro at the University of Buenos Aires have successfully performed cholecystectomy, or removal of the gallbladder, using ground breaking NOTES techniques.

The procedure allows access to the abdominal cavity and removal of organs without the need for visible incisions.

Using a hybrid NOTES technique including a laparoscopic control, videogastroscope and forceps, doctors successfully removed the gall bladder through the vagina in 21 of the 22 patients enrolled in the study. One patient could not complete the procedure due to pelvic adhesions.

All 21 patients healed successfully with no complications, were able to resume sexual activity without pain following the brief recovery period, and reported no change in sexual desire.

All the above uses of NOTES were presented in detail at the Digestive Disease Week 2009 (DDW)- the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. (ANI)

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