“Not ready for prime time” was the verdict on natural-orifice surgery from Dr. Michael Marohn of Johns Hopkins at the recent 21st Century Surgery conference in Irvine.
But medical-device maker USGI of San Clemente is working hard to change that.
In recent weeks, surgeons at UC San Diego Medical Center removed the appendix from two patients without major incisions into the abdomen – once through the vagina, once through the mouth using an endoscopic surgical tool from USGI. These operations are the latest examples of Natural Orifice Translumenal Endoscopic Surgery, or NOTES, an experimental procedure aimed at reducing pain and decreasing patients’ recovery time.
Dr. Santiago Horgan, a NOTES surgeon and director of UC San Diego’s Center for the Future of Surgery, says his group plans further operations if the latest patients continue to do well.
But the OpNotes blog reports:
Dr. Horgan warns, however, that NOTES is not yet ready for wide adoption, and that years of technical development are still needed. “The problem is that eighty percent of the endoscope still goes to the light and the camera, while only twenty percent goes to the working channels,” he said. “It needs to be the other way around. Although companies like USGI have been working on better platforms, we still don’t have an ideal NOTES scope.”
Medical blogger Dr. Rob Oliver is harsher in his evaluation of how NOTES appendectomies compare to the current standard for laparoscopic appendectomies. He calls it a “really, really stupid idea”:
Take an operation that is typically performed safely in less then 30 minutes with minimal pain or morbidity and turn it into one that lasts 3 hours, introduces unnecessary risk, and has no conceivable advantage. What do they call that at the University of California San Diego? They call it progress (!!!!!) …
The absence of three nearly invisible 3-5mm scars, with no advantage in length of stay, with the addition of a hole in your rectum, vagina, or stomach (which all can leak), with significantly prolonged surgery adding cost, increased nausea, and increased risks of deep vein thrombosis is somehow supposed to be an improvement? This is a technique that needs to be put back in a holding pattern indefinitely where safe procedures exist until you can come up with some compelling rationale for doing them.
Not surprisingly, USGI’s approach is more upbeat:
Operating through the body’s natural orifices offers promise for less pain, shorter hospital stays, reduced risk of wound infection and no external scars – and is rapidly becoming an option demanded by patients and healthcare providers. USGI offers surgeons and gastroenterologists the tools they need to offer millions of potential patients a less invasive surgical option.
Related links:
- All a-Twitter at 21st Century Surgery conference
- Surgeons remove diseased appendix through mouth, vagina
