Minimally Invasive Surgery (MIS) is entering an exciting new phase with further developments in the marriage of laparoscopic and interventional endoscopic techniques. The result of these developments are MIS procedures that are less invasive, safer, and achieve better outcomes for patients.
Physicians interested in keeping abreast of the advances in endolumenal techniques, including Natural Orifice Translumenal Endolumenal Surgery (NOTES), should view this webcast, which features innovators in the field from NewYork-Presbyterian Hospital.
In April 2007, NewYork-Presbyterian Hospital surgeons performed what is thought to have been the nation's first NOTES surgery—a transvaginal cholecystectomy procedure. Since then, they have successfully completed an additional two NOTES procedures. The approach will be discussed during the webcast.
Research in the field of transvisceral endoscopy, still in its infancy, has required a confluence of the operative skills of both gastroenterologists, more at ease with the use of flexible endoscopy, and specialized surgeons, more comfortable with dissecting into tissue planes and handling the need to convert to open procedures. This combined expertise has been instrumental in the creation of new approaches to certain localized diseases.
Advantages for use of the NOTES procedures may include the potential for painless, scarless and nearly recovery-free surgery, reduced risk of adhesions, reduced complications from wounds, reduced use of anesthesia, shorter hospital stays, and better cosmesis. Experience in humans is still limited, however, and there are potential risks to the approach, such as creating an incision through the stomach lining, which is not a sterile environment. A few early proponents of NOTES and hybrid NOTES procedures, mindful of the tremendous potential of this surgical approach, have proceeded with cautious experimentation.
One surgical endolumenal technique to be discussed during the webcast is a combined colonoscopic-laparoscopic procedure for removing a benign growth from the colon—thereby avoiding bowel resection by open or laparoscopic methods. Possible benefits include the ability to send the patient home by the day after surgery. Whereas a gastroenterologist would be concerned about removing a large polyp or bleeding lesions within the intestine because of potentially injuring, perforating or burning the bowel wall, this new hybrid procedure allows for the complete removal of the polyp or lesion. If the intestinal wall looks burned, thinned or injured in any way, the surgeon can immediately visualize the area and place a few stitches to repair the injury.
There are also advanced therapeutic endoscopic applications incorporating some of the newer NOTES technology. Endolumenal procedures such as endoscopic submucosal dissection (ESD) use tools to grasp, manipulate, spread, divide, cauterize, cut, suture and re-appose tissue. Some of these techniques can now be used even within the peritoneum through endoscopes.
This webcast will also feature some advanced endoscopic non-NOTES procedures, highlighting the interplay between endoscopic accessories devised for peritoneal translumenal surgery that also happen to work well for more common interventional endoscopic procedures. Dozens of new NOTES-related technologies have been introduced in the last couple of years, and the significant interest in NOTES will likely spur industry into creating advanced, miniaturized technology, which will also result in benefits for certain non-NOTES procedures as well.
This webcast will give us an exciting glimpse into the dawning of the new era of endoscopic surgery.
The webcast will be broadcast on November 28, 2007, at 7 p.m. E.S.T. Participants will include Dr. Marc Bessler, director of laparoscopic surgery and director of the Center for Obesity Surgery at NewYork-Presbyterian/Columbia University Medical Center and assistant professor of surgery at Columbia University College of Physicians and Surgeons; Dr. Peter D. Stevens, director of endoscopy at NewYork-Presbyterian/Columbia and assistant professor of clinical medicine at Columbia University College of Physicians and Surgeons; Dr. Jeffrey Milsom, chief of colorectal surgery at NewYork-Presbyterian/Weill Cornell Medical Center and DeCosse Distinguished Professor of Surgery at Weill Cornell Medical College; and Dr. Felice Schnoll-Sussman, gastroenterologist at NewYork-Presbyterian/Weill Cornell and assistant professor of medicine at Weill Cornell Medical College.