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DDC Champions Scarless Abdominal Surgery Research

January 19, 2007 – Having surgery to repair various infirmities inside the abdomen could be done without leaving a scar, according to a new technique that could revolutionize many invasive operations, announced MUSC’s Digestive Disease Center.

The technique, done through natural orifice translumenal endoscopic surgery (NOTES), is in its infancy, but it opens up an exciting new field of minimally invasive gastrointestinal surgery that involves gaining access to the abdominal cavity through natural orifices (mouth, anus, vagina, bladder). NOTES does involve an intentional perforation, which enables a therapeutic maneuver (tubal ligation, appendectomy, cholecystectomy, lymph node excision, etc.) with flexible endoscopes, and then sealing the perforation with clips or other devices.

“The end result is abdominal surgery without an abdominal wall incision, and consequently without external scar or risk of external wound infection or hernia, with potentially even shorter recovery times,” said Joseph Romagnuolo, M.D., director of clinical research in the division of Gastroenterology and Hepatology. “It may be particularly appropriate for the obese patient, in whom even laparoscopic approaches can be challenging.”

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Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) is a joint initiative supported by the American Society for Gastrointestinal Endoscopy (ASGE) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), which recently received $1 million for Ethicon Endo-Surgery Notes Research Fund. This fund also awarded MUSC more than $65,000 to support a project looking at the potential reduction in adhesions with transgastric NOTES versus laparoscopic intra-abdominal surgery, Romagnuolo said.

The NOSCAR project involves a pig survival study and examines the rate and extent of adhesions three weeks after transgastric versus laparoscopic techniques for colonic perforation and repair in a pig model. MUSC pilot data (led by Binh Pham, M.D., during his endoscopic retrograde cholangiopancreatography fellowship) suggested the potential for a clinically significant reduction in adhesions with the NOTES technique compared with either laparoscopic or open surgery.

The current project, led by principle investigator, Romagnuolo, with co-investigators, Katherine Morgan, M.D., and Robert Hawes, M.D., was selected among over 80 applications in a very competitive cycle with a funding rate of roughly 15 percent.

MUSC, with its expertise in advanced therapeutic GI endoscopy and advanced GI laparoscopy, combined with its excellent collegial relationships among gastroenterologists and GI surgeons within the DDC, is well-poised to lead the nation and indeed the world in the exciting field of NOTES research, Romagnuolo said.