More than 150 patients in the US have had ground breaking surgery called NOTES — natural orifice translumenal endoscopic surgery — aimed at reducing scarring, pain, infection and recovery time. These procedures are already being more widely used internationally.
For example, recently an obese woman who had been struggling with weight loss for almost 50 years had most of her stomach removed through her mouth She underwent a sleeve gastrectomy, a surgery that eliminates 80 percent of the stomach, using a new technique that removes organs and tissues through natural bodily openings. Her only complaint after the operation was having a dry mouth. Dr. Santiago Horgan, director of minimally invasive surgery at the University of California, San Diego Medical Center, performed the intervention. Dr. Horgan has removed gallbladders, appendix and other organs using this technique.
Orifice operations now more common NOTES operations are still experimental but becoming more common in the few medical centers. Clinical trials to test the operations’ safety and effectiveness are still in progress.
Horgan has performed two-thirds of the NOTES surgeries in the U.S., becoming a pioneer in a fledging field that began here with surgeries in animals, mostly pigs, in 2004.
Dr. Marc Bessler, a surgeon at Columbia Presbyterian Hospital in New York, performed the first U.S. NOTES procedure on a human in 2007 by removing a woman’s gallbladder through her vagina.
Different Orifices for Different Procedures
Since then, the field has expanded, albeit slowly. Put simply: “It’s surgical procedures through different ports,” said Dr. Michael Kochman, co-chairman of the research committee for NOSCAR, the Natural Orifice Surgery Consortium for Assessment and Research. (NOTES and NOSCAR are trademarked terms).
The idea is to use a direct route to reach the organ, tumor or other tissue, make a small incision and then remove it through the same pathway.
Surgery can be performed through the mouth, vagina, rectum, urethra or bladder. In women the vagina is often the easiest way to perform this surgery according to the Doctors TV program on CBS Reality, because there is an empty channel immediately above the vagina known as the cul de sac.
The decision on which orifice will be used is usually based on the specific situation as well as the preference and experience of the surgeon performing the operation.
Some operations are done as hybrid procedures that use laparoscopy in conjunction with natural orifice removal.
Less Pain, No External Scars, Faster Recovery
NOTES surgeries mean no large external scars less pain and a shorter recovery with patients able to resume normal activities in seven days as compared to six weeks with traditional surgeries.
Although NOTES surgeries are widely done internationally they are still tightly controlled in the US.Clinical trials in humans comparing NOTES gallbladder surgeries with ordinary laparoscopic surgeries are underway and so far the results indicate that in addition to less pain and shorter recovery times, there has been very little infection or other complications with this surgery.
Early studies indicate that NOTES Expansion has been hampered by the slow development and approval of equipment specifically designed for NOTES surgeries.
In addition, doctors have to make sure to perfect techniques for sealing internal wounds to ensure that they are routinely secure and safe.
Many people feel squeamish at the idea of having organs removed through their mouths or other orifices. Experts say the caution around NOTES procedures mirror the concerns about laparoscopy when it was first introduced.
Right now, the only way to schedule a natural orifice surgery (NOTES) surgery in the US is through a hospital where an institutional review board has vetted the procedure and a patient can join a clinical trial. But this surgery is expected to become normal procedure once equipment, research and demand allow and public opinion adapts to this revolutionary idea.
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