Surgery without all the blood

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 infection."

"'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 meetings,' 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 operating 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 Solutions 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 gastrointestinal professional societies are now working side by side with instrument 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."


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