Evolution of NOTES Surgery for Esophageal Disorders
Surgeons at UC San Diego Medical Center have performed the nation’s first incision-free myotomy, a procedure to treat achalasia, a distressing disorder which causes difficulty swallowing, regurgitation and chest pain. The innovative surgery, performed through the mouth, is the most recent in a series of groundbreaking clinical trial surgeries being evaluated by the UCSD Center for the Future of Surgery.
Santiago Horgan, MD,
Chief of Minimally Invasive Surgery
at UC San Diego
“With dramatic advancements in medical devices, we can now perform complex surgeries through the mouth with no external incisions,” said Santiago Horgan, MD, chief of minimally invasive surgery and director of the UC San Diego Center for the Future of Surgery. “What we are seeing is the evolution of laparoscopic surgery into more specialized procedures that require no incisions at all.”
Laparoscopic surgery to treat achalasia is called the Heller Myotomy, a two hour procedure requiring up to six small incisions in the abdomen to divide the esophageal muscle. During this traditional procedure the surgeon cuts the muscles of the lower esophagus in order to let food and liquid pass to the stomach. Horgan’s technique, known as natural orifice translumenal endoscopic surgery, is performed entirely through the mouth in less than 90 minutes.
John Slepicka, 49, of Oceanside has suffered from chronic achalasia for two years resulting in a 30 pound weight loss.
“Over time I could not eat the foods I love. I could no longer go to restaurants. My friends said I looked unhealthy,” said Slepicka. “When I tried to eat, the food would get stuck in my throat. I would swallow air or stand up to get the food down. I worried that I had cancer or a tumor that was preventing the food from dropping down.”
The Center for the Future of Surgery
is a pioneer in for achalasia.
Achalasia is a rare and progressive disorder of the esophagus that impairs the ability to swallow. Achalasia is characterized by abnormal enlargement of the esophagus, an inability of the esophagus to push food down toward the stomach, and failure of the ring shaped muscle of the lower-esophagus to relax and allow food to pass into the stomach.
“With prior surgeries my post-operative pain was a 13 on a scale of one to ten. Because this surgery was done without cuts, I don’t feel like I’ve even had a procedure,” said Slepicka. “I participated in the trial because I wanted to help find a potential new treatment for achalasia that would not mean major surgery.”
The UC San Diego Center for the Future of Surgery is investigating, developing and teaching the next generation of scarless and minimally invasive surgeries. Horgan’s surgical team was the first in the U.S. to remove an appendix through the mouth and the vagina. A pioneer in natural orifice translumenal endoscopic surgery, the Center is focused on increasing the number of scar-free therapeutic solutions available to patients worldwide.
The Center is scheduled to move into the UC San Diego School of Medicine Medical Education Building. The Center will be the largest surgical training and research center in the United States.
Members of the surgery team included: Santiago Horgan, MD, Garth Jacobsen, MD, Ozanan Meireles, MD, Tom Savides, MD, Mike Sedrak, MD, and Mark Talamini, MD.
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