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NOTE surgery – to combat obesit

According to doctors, it would be safer to carry out a stomach-stapling surgery by introducing a tube through the mouth than using an incision. //

Around 1 million bariatric surgeries have been carried out across the globe. This surgery is recommended for weight loss and it involves stapling of the stomach, making it smaller, as a result, people eat less.

“Doing the surgery without incisions will make it a lower-risk, lower-cost proposition and may be applicable to patients who are less obese than those who are currently considered for surgery,” said Dr. Philip Schauer, head of bariatric surgery at the Cleveland Clinic, which is hosting a three-day meeting on obesity.

All surgical procedures have undergone a transformation due to the advent of laparoscopic surgery, also known as “keyhole” surgery. The demand for bariatric surgery went up particularly in 1990s. Only a few small cuts are needed for this surgery.

“I believe we are perhaps on the verge of another revolution,” said Schauer, who was recently named president of the American Society of Bariatric Surgery. Natural orifice transendoscopic surgery, or NOTE, does not need any incision as devices, like long tubes with robotic arms and staple guns, can be inserted through the mouth and sent down through the esophagus.

“Another possibility is inserting a sleeve, or a tube, into the intestines that would interfere with calorie absorption. Those are about five to 10 years away,” he said. “If the work to be done involves the lower portion of the intestines, instruments can be inserted through the rectum,” he added.

“Using a natural orifice, like the mouth or the rectum, would drive down costs even more because the procedure could be done without anesthesia, which would also make it less risky,” said Schauer. “Gaining access to the organ you want to work on is half the trauma,” he said. “If there’s less risk, maybe we could do ( bariatric surgery) on patients with a lower BMI, maybe under 35, as a preventive operation.”

Obesity is generally measured by body mass index, or BMI. Nearly 1/3rd of the adults in the U.S. are obese. Dean Geraci, director of market development for auto suture bariatrics at Tyco, said, “It takes years to design these products and get them approved. Engineers have to work with surgeons to determine techniques and then the devices have to go through the regulatory process, which can also be lengthy.”

Venture capitalist Dr. Lee Wrubel, a general partner at Foundation Medical Partners, said, “An investor must have a 10-year horizon. A lot of us who didn’t invest in this area five years ago are glad we didn’t.”


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