Does the Notes approach have many potential advantages such as no external scars, cause less pain, and faster recovery? Is NOSCAR surgery the natural evolution of endoscopic surgery? If a patient is offered a surgical option that would leave no scar, versus one with a little scar, which option would be chosen? IIP > Read on here > http://www.oregonlive.com…
Last May, Portland surgeon Lee Swanstrom threaded a tiny set of cutting and grasping tools through a tube down the throat of a 35-year-old patient and into her stomach. Viewing his way with a fiber-optic video camera, Swanstrom cut a hole through the stomach to reach an inflamed gallbladder, which he carefully cut free and pulled through the stomach, up the throat and out the patient’s mouth. Swanstrom is one of the leading advocates of “natural orifice” surgeries — getting access to internal organs through the mouth, vagina or rectum…
And, it might become the method of choice for a wide variety of surgeries. Instrument companies are pouring money into better instruments, and surgeons around the world are avidly pursuing research. The surgical team at The Oregon Clinic was first in the United States to perform through-the-mouth gallbladder surgery, in a scientific study co-sponsored by Legacy Good Samaritan Hospital and Medical Center in Portland. Another team of surgeons in New York last April removed a woman’s gallbladder through her vagina. Doctors in India have performed an appendectomy through the mouth.
At other U.S. centers, surgeons operating through the mouth on pigs have tied fallopian tubes, and some say it might be possible to perform through-the-mouth heart surgery…Kalloo says colleagues scoffed when he first proposed natural orifice surgery and began experimental work in animals. “They wondered why you would do such a thing,” he says.
In conventional surgery, accidentally perforating the gastrointestinal tract is considered one of the worst possible errors, he says. Doing it on purpose seemed unreasonably risky. But in animal studies, Kalloo and colleagues showed that a few precautions could minimize the risk of infection. They administered antibiotics before surgery, rinsed the gastrointestinal tract with antibiotic solution and took care to minimize leakage from the stomach into the body cavity…
In theory, the method should cause less pain because it eliminates the need to cut through external skin and thick layers of muscles around the abdomen. And with no external scars, the cosmetic appeal is obvious.
He says the approach could one day enable surgeons to operate at the site of a car accident or on a battlefield…
In Portland, Swanstrom and colleagues are methodically comparing outcomes of natural-orifice gallbladder surgery with conventional laparoscopic, or keyhole, surgery in which a surgeon operates through small incisions in the abdomen. The group gained approval from a safety and ethics review board at Legacy Health System. Three equipment manufacturers — USGI Medical, Boston Scientific and Olympus — are providing instruments and technical assistance. The surgeons have performed six through-the-mouth gallbladder operations at Good Samaritan since May 2007. They had hoped to complete 25 cases by early 2008. Swanstrom says patients have been willing, but health insurers have not wanted to pay for the experimental surgery. More than half of patients randomly surveyed in doctor offices said they would prefer to have through-the-mouth surgery rather than conventional operations if they had to have their gallbladder removed, Swanstrom says a study by Legacy Health System and Northwestern University found…
Limited to using instruments at the end of a long flexible scope makes the surgery far more technically demanding than conventional surgery. Swanstrom says through-the-mouth gallbladder surgery takes several hours, about twice as long as a laparoscopic procedure. The incision made inside the stomach to reach the gallbladder is less than an inch and virtually painless. Patients can eat normally as soon as they wish after surgery. The patient’s greatest complaint is having a severe sore throat…
While Oregon Clinic surgeons continue the gallbladder study, they are already gearing up to try other through-the-mouth surgeries. They plan to begin testing stomach-valve repair surgery in patients with diabetes in about a year, Swanstrom says. Swanstrom speculates that within 10 years, it may be common for patients to have gallbladder surgery done this way in a doctor’s office rather than an operating room. He envisions many other uses: taking biopsies of tumors, operating on the lungs, performing gynecological procedures and intestinal surgery…
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