Is the future of surgery painless and scarless?

NOTES advances unveiled at DDW 2008

SAN DIEGO, CA (May 18 2008) – A sophisticated new surgical technology holds promise for future painless and scarless surgery with shorter recovery times than laparoscopic surgery. New research supporting the safety and efficacy of natural orifice translumenal endoscopic surgery (NOTES^TM) and detailing the outcomes associated with new tools and robotic applications will be presented today at Digestive Disease Week^® 2008 (DDW^®). DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

“The research developments presented today are continuing to demonstrate the great potential of this exciting new surgical procedure,” said Pankaj J. Pasricha, MD, FASGE, professor of medicine, gastroenterology and hepatology, 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.”

NOTES is performed by passing an endoscope through a natural orifice then through an internal incision in the stomach, vagina, bladder or colon, thus avoiding any external incisions or scars.

A Prospective Randomized Controlled Trial of NOTES versus Laparoscopic Distal Pancreatectomy, Preliminary Results (Abstract #881)

Investigators have conducted the largest and most rigorously controlled study of natural orifice surgery to date. The study showed that while NOTESTM is more time-consuming than traditional (laparoscopic) surgery, it is equally successful. The study also demonstrated that complex surgery with a high rate of complications could be performed via the mouth using a flexible endoscope.

“NOTES is an area of promise in active development,” said Field Willingham, MD, MPH, senior fellow in the gastrointestinal unit at Massachusetts General Hospital. “The opportunities with NOTES are significant and should some day provide patients with a viable scarless and painless option for certain medical procedures.”

Previous NOTES research has involved small sample sizes and no control groups. This prospective, randomized controlled trial compared the efficacy of endoscopic transgastric distal pancreatectomy (ETDP) to laproscopic distal pancreatectomy (LDP). Investigators randomized twenty-eight 45kg swine to EDTP or LDP and then compared the results based on an extensive post-operative analysis. The procedure time for EDTP was significantly greater versus LDP (1:52 versus 0:32 hour), but investigators found no clinical or survival difference between the NOTES and laparoscopic approaches.