“NOTES has the potential
to revolutionize the way some operations are conducted” David Rattner, MD, Chief of Gastrointestinal
and General Surgery, MGH
Guest Author: Patricia Sylla, M.D., Instructor of Surgery at Mass General & Harvard Medical School
7 December 2009, Boston - In
the early days of November a groundbreaking surgical procedure, that
we put through years of careful testing, was finally ready to be
performed by our international team bridging Barcelona and Boston. Our
patient was a 76 year-old woman diagnosed with a malignant tumor of the rectum that
would traditionally require painful abdominal surgery and a long
recovery period. However,
she underwent our new procedure that left only tiny scars resulting in significantly
reduced pain and shorter recovery time. The procedure I
preformed, alongside my colleague Dr. Antonio Mª de Lacy of the
Hospital Clinic, was transanal NOTES rectal cancer resection using
Transanal Endoscopic Microsurgery (TEM).
You won't yet find TEM on Wikipedia, but it has been increasingly used in the field of NOTES (Natural Orifice Translumenal Endoscopy Surgery), born from the similar field of Endoscopic Surgery. The idea is to use the natural openings and orifices of the body to enter the abdomen, colon, or other areas to preform lifesaving surgeries. Our TEM technique uses rectal endoscopy to introduce a specially-designed proctoscope and CO2 system that creates a working space within the rectum and allows us to introduce the needed instruments.
We've
known for a long time that less invasive surgery can be associated with better outcomes. For this reason we have been working across institutions to develop this surgical application for a crucial area of the body while having the smallest surgical profile possible. Transanal
NOTES expands upon recent advances in other similar surgical areas of
the body (mainly the abdomen), but now aims to address an important
need in diseases of the colon and rectum, including colorectal cancer.
This first procedure represents a great example of successful Collaborative Medicine. However, it also brings us a renewed awareness that as treatment for diseases of the body improve through technology and collaboration, we need to be proactive as patients. As a physician, I carry with me the determination to care for the lives of those around me from many perspectives. This means that as new devices and procedures are developed for saving lives, we must work to pair those advances with a proactive patient focused approach to health.
I would like to give special thanks to Dr. David Rattner, my colleague and mentor and an integral part of our research over the past years. As well as the entire NOTES collaboration, the surgeons and endoscopists at Mass General Hospital, Brigham and Women's Hospital, Beth Israel Deaconess Hospital, and Dartmouth Medical Center.
You can read more about this procedure here
Patricia Sylla, M.D.
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