Navigation Links
Z-shaped incision enhances minimally-invasive surgery
Date:12/17/2007

A novel surgical technique allowing doctors to operate on patients by making a Z-shaped incision inside the stomach could potentially replace certain types of conventional surgery in humans, according to Penn State medical researchers who have successfully demonstrated the procedure in pigs.

If the technique ultimately proves successful in human trials, researchers say it could circumvent the long painful recovery times and medical complications associated with surgery.

The new approach, known as NOTES (natural orifice transluminal endoscopic surgery), involves using a natural opening in the body, in this case the mouth, to advance a flexible video endoscope into the stomach.

Using this tube, and the instruments contained within it, doctors currently make a small straight incision in the stomach to gain access to the abdominal cavity and the organs requiring attention.

"Theoretically, by eliminating body wall wounds with their associated complications and allowing some procedures to be done without general anesthesia, this method could leave a truly minimal surgical footprint, and may even allow certain procedures to be done outside a traditional operating room," said Matthew Moyer, M.D., a gastroenterology fellow at Penn State Milton S. Hershey Medical Center.

But he cautioned that NOTES is still in the developmental phases and even a simple procedure may be fraught with potential complications at this point.

"One of those barriers is the closure of the access site," said Moyer. "In other words, the opening made in the stomach must be reliably and safely sealed off at the end of the procedure."

Moyer and his Hershey Medical Center colleagues Eric M. Pauli, M.D.,resident surgeon; Randy S. Haluck, M.D., director of minimally invasive surgery and assistant professor, and Abraham Mathew, M.D., director of endoscopy and assistant professor, all at Penn State College of Medicine, believe their technique elegantly solves the problem.

The key to their approach lies in the way the flexible probe exits the stomach. Instead of cutting straight through the stomach wall the researchers guide the endoscope so that it first tunnels under the mucous membrane of the stomach wall for a while before exiting near an organ to be operated on. The endoscope essentially charts a Z-shaped path.

This new technique, known as STAT (self-approximating transluminal access technique), has two main advantages according to Moyer. There is significantly less bleeding involved and the Z-shaped tract effectively seals itself due to pressure created on the abdominal wall by normal breathing.

The team published its findings in a recent issue of Gastrointestinal Endoscopy.

The technique has other advantages as well. "Most people operate straight through the gastric wall and then use a bunch of complex maneuvers to get the endoscope where it needs to be," said Pauli. "And it can get difficult to operate because the endoscope is upside down and in a reverse position."

By tunneling through instead, he points out, doctors can maintain a directional sense and guide the endoscope more accurately.

"There are landmarks in the mucous membrane such as specific blood vessels and groupings of blood vessels. We can also see through the wall of the stomach in some areas to guide the endoscope to the organ we want to operate on," Pauli said.

The researchers have so far operated on 17 animals and only one of them has developed a minor complication.

Once they have perfected their tunneling technique, Moyer and colleagues will try to figure out how exactly to remove surgical specimens from an operation.

"The gall bladder, small tumors, even the ovaries are potentially removable through this technique," said Mathew. "We could in theory make the tunnel as big as we want, and take something out into the stomach and cut it into small pieces before extracting it."

If successful, the procedure in humans could translate into significantly shorter recovery times, little or no pain, less anesthesia and without surgical scars. But the researchers acknowledge it may be a while before their surgical technique reaches human trials.

Mathew said he and his colleagues are confident that their technique lets them get the endoscope out of the stomach and back in safely with currently available instruments. "We have to perfect the technique so we can fully understand the risks," he added.

The Penn State researcher envisions minimally invasive surgery being employed to help patients who are critically ill and may not be able to tolerate a traditional surgery or leave the ICU. In such cases, doctors could access the internal organs and perform procedures such as a biopsy to make a better diagnosis or even perform intestinal bypass surgery.

According to Pauli, these findings could accelerate the pace of research in minimally invasive surgery and ease the way for other breakthroughs.

"We are looking at some fundamental questions: can we get the endoscope in safely, can we get it out safely, and can we get it at the organ we want to operate on. Those are the questions nobody has really answered," he said.


'/>"/>

Contact: Amitabh Avasthi
axa47@psu.edu
814-865-9481
Penn State
Source:Eurekalert

Related medicine news :

1. Single-incision belly-button surgery to remove kidney performed first at UT Southwestern
2. Small Incisions Make Heart Valve Surgery Safer
3. The First Incisionless Transoral Fundoplication for Treatment of Gastroesophageal Reflux is Performed in the U.S. at Ohio State University and Oregon Health & Science University Medical Centers
4. PEAK Surgical Announces Positive Surgical Incision Wound Healing Results With the PEAK PlasmaBlade(TM)
5. Creative Technology Services Enhances its Global Competitiveness with Additional Regulatory Certifications
6. American Heart Association Enhances eLearning for Emergency Cardiovascular Care (ECC)
7. Study finds limiting work hours for surgical residents enhances training
8. McGraw-Hill Professional Enhances Library Access to Medical and Engineering Resources
9. Sterling Life Enhances Marketing Operations Controls to Better Serve Medicare Beneficiaries
10. Creatine in addition to exercise enhances strength in older adults
11. The Joint Commission Enhances Quality Check Website
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/24/2017)... ... May 24, 2017 , ... Rob Lowe is a sought after ... Public Television. “Informed” brings the public important topics from all aspects of life, and ... feet and issues surrounding feet and ankles. , Podiatry is essential to people’s overall ...
(Date:5/24/2017)... , ... May 24, 2017 , ... Technique, technique, technique ... injury when either lifting weights for strength training and exercise or simply lifting heavy ... . , “Body position is everything,” Dr. Chang says. “Improper technique in lifting anything ...
(Date:5/23/2017)... ... ... Axiad IDS , a leading provider of trusted identities for enterprise, ... a “Top 25 Cybersecurity Companies 2017.” Axiad IDS received this honor in ... address potential cybersecurity threats before they happen. The annual list of top ...
(Date:5/23/2017)... ... 2017 , ... Cambridge, MA, May 23, 2017—Total costs per ... a Workers Compensation Research Institute (WCRI) study, a contrast from the increases of ... Benchmarks, 17th Edition looks at indemnity and medical payments for workers’ compensation ...
(Date:5/23/2017)... ... May 23, 2017 , ... The National Council ... pleased to announce the organization’s Certified Strength Coach credential has earned accreditation from ... (CSC) program validates the competency of qualified candidates for jobs in the Strength ...
Breaking Medicine News(10 mins):
(Date:5/4/2017)... WAYNE, Pa. , May 4, 2017 /PRNewswire/ ... made from thermoplastics and other highly-engineered materials, is ... Microextrusion tubing has been developed in recent ... neurovascular interventional therapies and surgical applications. More expensive ... used to produce microextrusion tubing due to their ...
(Date:5/3/2017)... May 3, 2017  Kalorama Information notes that ... percent next year and this is projected to ... stem cell (HSCT) or bone marrow transplants require ... are well-suited for this task. This according to ... Kalorama Information. The various PCR-based methodologies, Sanger sequencing ...
(Date:5/2/2017)... YORK and LONDON , ... of market intelligence, MarketResearch.com is pleased to announce a ... AB that allows for the marketing and distribution ... analyses through the MarketResearch.com website. The new ... to complete product descriptions and tables of contents from ...
Breaking Medicine Technology: