Natural Orifice Translumenal Endoscopic Surgery (NOTES)
The Center for Minimally Invasive Surgery at OSUMC is a nationally recognized leader in the development and implementation of incisionless surgery, or NOTES (Natural Orifice Translumenal Endoscopic Surgery).
The development of laparoscopic surgery, which utilizes minimal abdominal incisions to perform surgery, greatly reduced patient postoperative pain and recovery time. NOTES is a potential improvement on the laparoscopic technique. NOTES is not always entirely incisionless; in some surgeries, internal incisions must be made to access the surgical site. However, the elimination of skin and muscle incisions may further decrease postoperative pain and recovery time, and eliminate visible surgical scarring.
The first NOTES trial conducted at OSUMC sought to evaluate the bacterial load and bacterial contamination of the abdomen during laparoscopic Roux-en-Y gastric bypass while the gastrotomy is open to the abdominal cavity, as well as when no defect is present in either the stomach or bowel. Our second NOTES trial compared NOTES endoscopy versus laparoscopy in evaluating pancreatic masses. We have also instituted a trial of NOTES as an adjunct to identify a safe site for trocar placement in bariatric surgery. Future NOTES research will focus on endoscopic evaluation and biopsy of pancreatic head tumors and gastrotomy closure. Jeffrey Hazey, MD, is the principal investigator for our NOTES human clinical trials.
Transgastric Bacterial Contamination of the Abdomen
The objective of this study was to evaluate the bacterial load and bacterial contamination of the abdomen during laparoscopic Roux-en-Y gastric bypass while the gastrotomy is open to the abdominal cavity. Fifty patients who had intraoperative gastric incisions were evaluated for peritoneal contamination. Only six patients had cross contamination of the peritoneal cavity from gastric isolates. We continue to collect and analyze gastric samples during active NOTES trials.
Diagnostic Translumenal Endoscopic Peritoneoscopy
The objectives of this study are to determine the feasibility of transgastric endoscopic peritoneoscopy in patients requiring diagnostic laparoscopy; compare the sensitivity and specificity of transgastric endoscopic abdominal exploration to laparoscopic abdominal exploration in patients requiring diagnostic laparoscopy, and quantitatively and qualitatively measure the bacterial load and bacterial contamination of the abdomen during transgastric endoscopic peritoneoscopy while the gastrotomy is open to the abdominal cavity. Ten subjects were enrolled in the initial protocol, which demonstrated that transgastric diagnostic peritoneoscopy is both feasible and safe in humans. We are currently recruiting an additional 20 subjects.
Transgastric Peritoneoscopy for Evaluation of the Abdominal Wall to Direct Laparoscopic Trocar Placement
The objective of this study is to gain safe transgastric access to the abdomen in order to visualize the abdominal wall to assist in safe trocar placement in the morbidly obese patient. In addition, peritoneal washings are obtained to assess transgastric bacterial contamination, intra-abdominal adhesions via transgastric peritoneoscopy are identified, characterization of endoscopically induced peritoneum insufflation is investigated, and the feasibility of adhesiolysis is investigated. This trial is active and currently continuing to enroll subjects.
Novel repair techniques for gastro-intestinal perforations and gastrotomy closure
The objective of this study was to evaluate a bioabsorbable closure device for gastric perforation repair in a canine model. In 12 animals, the application of a bioabsorbable device resulted in durable closure of the gastric perforation with physiologic healing of the injury site.
Proposed NOTES research includes a randomized clinical trial comparing diagnostic laparoscopy to diagnostic transgastric endoscopic peritoneoscopy for staging of pancreatic and esophageal cancer and continued animal model investigation into a gastric closure device.