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Surgeons Amber Khan and Ajay Goyal
use a video image as a guide while performing an incisionless
weight-loss procedure on a patient. |
Tuesday, July 08, 2008
By ANGELA STEWART
Star-Ledger Staff
Imagine having surgery without being cut.
Doctors in New Jersey are now performing some abdominal operations this way and
believe the "incisionless" technique will soon become more common on
other areas of the body as well.
Overlook Hospital in Summit and CentraState Medical Center in Freehold are among
the hospitals performing weight-loss surgery using the groundbreaking method,
officially called natural orifice translumenal endoscopic surgery, or NOTES.
It is reducing recovery time, as well as patient pain and in fection.
"I had the surgery done at 8 o'clock in the morning and left the hospital
at 11:30. I went back to work the next day," said Debra Bower, 45, of Hazlet,
who had gained weight following her March 2007 gastric bypass operation and wanted
doctors to reduce the size of her stomach pouch.
Rather than making an incision in Bower's abdomen, a device was introduced into
her stomach through the mouth. The device included a flexible tube encasing a
fiber-optic camera. Non-absorbable suture-like material was also introduced through
the mouth and lowered to the stomach.
Once the tube reached Bower's stomach, the surgeons used the camera to put it
in the right position. Starting at the junction where the esophagus meets the
stomach, the surgeon fired clips in a clock wise direction to the junction of
the stomach and small intestine.
Doctors then operated, sewing the front and back of Bower's stomach together,
creating a smaller pouch. The procedure, which leaves no outside scarring, took
just 45 minutes to perform.
"We really see the wonderful benefit," said Morris Washington of Endo-Surgical
Associates of Central Jersey, who performed Bower's surgery at CentraState, along
with his physician colleague, Ragui Sadek, earlier this month.
Besides "re-do" operations on gastric bypass patients, the technique
is also in the early stages of development for use on patients suffering from
severe heartburn, or acid reflux. It has also been used experimentally in gall
bladder removal and in some gynecological surgeries. Doctors say it can be adapted
for other procedures in the body by using other natural entry points.
"This is one of the biggest topics at surgical technology meet ings," said
Melvin Scott, director of minimally invasive surgery at Ohio State University,
where it is being used in conjunction with more traditional operative techniques
for diagnosing abdominal cancers.
Scott, along with Ohio State surgeon Jeffrey Hazey, were the first in the United
States to take the new technique into the operat ing room for abdominal surgery.
To perform the weight-loss procedure, doctors used a Food and Drug Administration-approved
sur gical device called StomaphyX, manufactured by EndoGastric So lutions of
Redmond, Wash. Bower, who weighed 350 pounds before her original weight-loss
operation last year, had the incisionless surgery performed in early June and
at the time of this writing was down to 265 pounds.
"It's a good procedure as long as you understand you still must do the hard
work of exercising and eating nutritious food, cutting out things like fast food," said
Ajay Goyal, director of bariatric surgery at Overlook Hospital, who also is performing
the procedure.
EndoGastric Solutions also makes another device, EsophyX, which is used to operate
on patients with chronic reflux.
Mark DeLegee, director of the Digestive Disease Center at the Medical University
of South Carolina, said surgeons are excited about the opportunities that lie
ahead with incisionless surgery. He said doctors from two gastrointes tinal professional
societies are now working side by side with instru ment manufacturers on tools
that would expand its use.
"It's a whole new area of medicine that, frankly, technology has to catch
up with," he said.
