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 NOTES surgery.

"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. Horgan said.

"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."

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