Incisions, Scars Out in New Abdominal
Surgery
Clinical trials awaited for procedure that is less invasive
than laparoscopy
By Trent Stockton Johns Hopkins
Medicine
Surgeries performed with specialized medical devices
requiring only small incisions, called laparoscopic
surgery, have many advantages over traditional open
surgery, including less pain, fewer complications and
quicker recoveries. Now, scientists at Johns Hopkins have
created a new surgical technique that in extensive animal
studies is safe and may improve even further the benefit of
minimally invasive surgery by leaving the abdominal wall
intact.
The new procedure, called flexible transgastric
peritoneoscopy, or FTP, is performed by inserting an
endoscope — a flexible mini-telescope — and
related surgical tools through the mouth and into the
stomach. After puncturing the stomach wall and the thin
membrane surrounding the stomach (the peritoneum, which
also lines the inside of the abdominal and pelvic
cavities), the doctors can see and repair any abdominal
organ, such as the intestines, liver, pancreas, gallbladder
and uterus.
"FTP may dramatically change the way we practice
surgery," said Anthony Kalloo, associate professor of
medicine
and director of
gastrointestinal endoscopy at
Johns Hopkins and lead author of a report describing the
new procedure in the July issue of Gastrointestinal
Endoscopy. "The technique is less invasive than even
laparoscopy because we don't have to cut through the skin
and muscle of the abdomen, and it may prove a viable
alternate to existing surgical procedures."
For their study, the investigators relied on standard
endoscopic equipment already in use, but they are awaiting
development of even better, specialized equipment before
they begin clinical trials on humans, sometime within the
next year. The researchers, including an international
think tank of gastroenterologists from five universities
called the Apollo Group, have already designed an
endoscopic sewing machine to close incisions.
The researchers first evaluated the technical
feasibility and safety of the procedure by performing liver
biopsy on pigs under general anesthesia. After washing the
stomach with an antibacterial solution to prevent
infection, a small incision was made to allow access to the
peritoneal cavity. The cavity was then filled with air to
increase the visibility of the organs, biopsy samples were
taken from the liver, and the incision was sealed with
clips. The pigs were monitored for 14 days following the
procedure and showed no signs of serious infection or other
complications, and the surgical site was completely
healed.
"Because the lining of the stomach repairs faster than
skin, recovery times should be reduced," Kalloo said.
Ironically perhaps, while a surgical injury to the lining
of the stomach or intestines is often considered a serious
medical condition because of the risk of infection, the
results of this study show that careful preparation and
monitoring can turn a potentially fatal situation into a
better and safe surgical technique, Kalloo said.
In a second study, the researchers evaluated the
safety of the new surgery for blocking the fallopian tubes,
or tubal ligation — an immediately effective,
permanent form of female birth control that works by
preventing an egg from traveling from the ovary to the
uterus. All five pigs that underwent the 20-minute
procedure recovered well without ill effects or any
abdominal scars, and the fallopian tubes remained
completely blocked.
Other investigators in this research are Sergey
Kantsevoy, Sanjay Jagannath, Cheryl Vaughn, Diana Scorpio,
Carolyn Magee, Laurie Pipitone, Vikesh Singh, Hideaki
Niiyama and Susan Hill. In addition to Kalloo, members of
the Apollo Group are Sydney Chung, Chinese University of
Hong Kong; Christopher Gostout, Mayo Clinic; Peter Cotton
and Robert Hawes, Medical University of South Carolina; Jay
Pasricha, University of Texas Medical Branch Galveston; and
Sergey Kantsevoy, Johns Hopkins.
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