Progress in appendix removal through mouth
16 July 2008
An appendectomy using endosurgical instruments passed through the
mouth and then through the stomach wall was demonstrated at the
Natural Orifice Surgery Consortium for Assessment and Research's (NOSCAR)
3rd International Conference on Natural Orifice Translumenal Endoscopic
Surgery (NOTES) in San Francisco last week.
The operation was performed by Dr Santiago Horgan, director of the
University of California San Diego Center for the Future of Surgery,
using the EndoSurgical Operating System (EOS) of USGI Medical, Inc. (USGI).
USGI Medical's Transport, the main platform of its
endosurgical operating system. The Transport has four channels — one for
the endoscopic camera and the remaining three for tissue grasping,
anchoring, suturing and cutting tools.
Dr Horgan removed an appendix and then fully closed the stomach
incision (the gastrotomy) from inside the stomach in front of the
meeting's 300 attendees on Saturday.
Dr Horgan became the first surgeon in the US to remove a patient's
appendix through the mouth in late March, his 22nd 'incisionless
surgery' procedure — ie no abdominal incision. In later cases, he used
USGI's EOS to close the gastrotomy through the patient's mouth following
a NOTES appendectomy, another US first.
The ability to close the gastrotomy from inside the stomach is
considered the major hurdle to the widespread adoption of Incisionless
"The ability to close a gastrotomy safely and securely from inside
the stomach represents the major leap forward in incisionless surgery
and will enable us to perform truly scarless NOTES procedures," Dr.
"Incisionless surgery technology has advanced significantly in recent
years and we now have access to expandable tissue anchors that fit
across the full thickness of the stomach wall and close the opening
without a risk of leaks. With the EOS, we now have an operating platform
for a wide variety of procedures."
NOTES involves passing surgical instruments through one of the body's
natural orifices, such as the mouth or vagina, to remove a diseased
organ such as an appendix or gallbladder. Operating solely through the
body's natural orifices eliminates external incisions and offers promise
for less pain, shorter hospital stays, lower healthcare costs and no
external scars compared to traditional and laparoscopic surgery.
"We're delighted to see leading surgeons use our EndoSurgical
Operating System to advance the NOTES field," said Eugene Chen, Chief
Executive of USGI. "Surgeons are also using the EOS to perform
incisionless procedures within the GI tract. We look forward to the day
when the millions of patients who require abdominal operations will have
an incision-free alternative to painful and invasive surgery."