Scar-free surgery on the cards

A new surgical technology may lead to painless and scar-free surgery with recovery times even shorter than those offered by laparoscopic surgery, US studies suggest.

Called natural orifice translumenal endoscopic surgery (Notes), an endoscope is inserted through a natural body opening, rather than through an internal incision in the stomach, vagina, bladder or colon. This avoids any external incisions or scars. The studies were presented at the Digestive Disease Week meeting, in San Diego.

"The research developments presented [at the meeting] are continuing to demonstrate the great potential of this exciting new surgical procedure," said Dr Pankaj J. Pasricha, professor of medicine, gastroenterology and hepatology at the Stanford University School of Medicine.

"Surgical advances like Notes may lead the way toward the adoption of even more minimally invasive techniques than laparoscopy and allow patients to return to their home, family and work more quickly," Pasricha said.

Time consuming, but successful
In one study, researchers at Massachusetts General Hospital (MGH) found that Notes was more time-consuming than laparoscopic surgery, but was equally successful. They also demonstrated that complex surgery could be performed through the mouth using a flexible endoscope.

"Notes is an area of promise in active development. The opportunities with Notes are significant and should some day provide patients with a viable scarless and painless option for certain medical procedures," said study author Dr Field Willingham, senior fellow in the gastrointestinal unit at MGH.

He did mention that tools used to dissect or retract during Notes procedures may pose some limitations. "It can be challenging to perform complex procedures such as holding traction while simultaneously dissecting tissue through a single Notes endoscope," Willingham said.

In another study, Johns Hopkins University School of Medicine researchers found that Notes can be used to view the entire uterus and to reach previously inaccessible areas. The findings from tests on ewes suggest that Notes may prove useful in performing lifesaving surgery on foetuses.

Notes could allow more complicated operations
Traditional laparoscopy or laparotomy can be limiting, because the uterus and foetus can only be accessed from the front. With Notes, doctors can reach any part of the uterus, no matter which way the foetus is facing.

"Our findings suggest that Notes may provide an avenue through which one can ultimately stage even more complicated operations in pregnant women and the foetus," said study author Dr Samuel A. Giday, an assistant professor of medicine in the division of gastroenterology and hepatology.

In a third study, University of Nebraska Medical Centre researchers found that combining Notes with small robotic devices resulted in excellent outcomes in more than 25 procedures performed on animals.

The procedures included abdominal exploration, bowel manipulation, cholecystectomy, intracorporeal suturing, partial splenectomy and liver resection.

The robotic devices - about the size of two lipstick tubes - have a central body, two working arms and a built-in light source. While this approach shows promise, it does have a number of limitations that need to be addressed before it could be available for use in humans, said study author Dr Dmitry Oleynikov, director of minimally invasive surgery at the medical centre. – (HealthDay News, May 2008)

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