Ideas for Surgery
TOGA
PMMA
Endoluminal gastric plication
Sutureless microvascular anastomosis
Powerlink XL
Capsule endoscopy
NOTES
Endobarrier
Scientific fraud

Ideas for Surgery

This month I have assembled several interesting new ideas, all of which share the characteristic of being truly minimal access in design and offer a range of new acronyms, new procedures and new toys.

Here is a site with a summary of some new and innovative ideas which can be applied in surgical practice.

TOGA Trans oral gastroplasty- Incision free surgery for obesity.

Is this new surgery an exciting option for severely overweight patients who do not respond to diet, exercise and drug therapy? Will the TOGA procedure help patients to lose weight and improve their health?

PMMA

There are a number of innovative NOTES devices designed to improve the function of the lower oesophageal sphincter. These include polymethylmethacrylate PMMA beads which can thicken the tissue and thus support the sphincter when the microbeads are implanted in local tissue adjacent to the LES. See a current contribution to the literature here

Endoluminal gastric plication for GERD

Here is another new approach. There is some interesting work in endoscopic suturing for gastro-oesophageal reflux disease using such devices as the NDO Plicator system, the Wilson-Cook Medical ESD system Sew-Right device and other Endoscopic Gastroplasty devices like the Bard Endocinch system.

 

Sutureless microvascular anastomosis.

At Stanford University School of Medicine, surgeons are working with chemical engineers to perfect a technique for sutureless microvascular anastomosis using thermoreversible poloxamers. “Anastomosis” is the term used to describe connecting both ends of cut blood vessels, so that the blood can flow through unrestricted. However, working under a microscope to connect the tubes of these tiny blood vessels is tedious, time-consuming, and requires a skilled microsurgeon. This new technique can connect blood vessels without sutures cutting the time taken for the preocedure by 50-85%.

Endovascular aneurysm surgery

Further developments have been taking place in the design of devices indicated for aortic aneurysm surgery where the aortic neck is greater than 26 millimeters in diameter. The Powerlink XL System offers the lowest profile catheter of all commercially available devices indicated for aortic necks greater than 26 millimeters?

Capsule endoscopy

Olympus Medical Systems Corp started selling the Endo Capsule, the company’s proprietary capsule endoscope for the small intestine in Japan this month.

NOTES

Surgeons have now performed NOTES style procedures on more close to 1000 patients worldwide, mostly in South America and India. There is considerable interest in Europe and a handful of surgeons began trying the approach in the United States.

The technique has been used mostly to remove gallbladders through the mouth or the vagina. A few patients have had appendix surgery and some work is being done on other areas including bariatric surgery. It is even appearing in paediatric surgery To address this emerging technology, a working group consisting of expert laparoscopic surgeons from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and a group of expert interventional endoscopists representing the American Society for Gastrointestinal Endoscopy (ASGE) came together for a meeting in New York City in July 2005. This group identified itself as the Working Group on Natural Orifice Translumenal Endoscopic Surgery, later the NOSCAR Joint Committee.

 

Endobarrier

Metabolic diseases such as obesity and type 2 diabetes have reached epidemic proportions worldwide. GI Dynamics is defining important new options for people who need to take control of their weight and their health. The EndoBarrier™ technology is designed to modify metabolic pathways by lining a portion of the gastrointestinal tract. This is done via an endoscopic procedure. This noninvasive approach may represent a significant advancement over traditional pharmaceutical and surgical interventions.

Scientific fraud

The New Scientist has reveiwed seven of the most outrageous scientific hoaxes.

My favourite is the well established story of New York physicist Alan D Sokal who wrote a magnificent spoof article and had the whole article which was loaded with nonsensical jargon published as a genuine contribution to the literature. Among other things he argued that quantum gravity is a social and linguistic construct. Great stuff! Links to this and more from the New Scientist.

Hope to see you at the Triennial events. More next month. Till then...

Yours

David Galloway