Massachusetts General Hospital

Top, left to right: Denise Gee, MD, Christopher Morse, MD, Patricia Sylla, MD. Bottom, left to right: Field Willingham, MD (now at Emory University), David Rattner, MD, William Brugge, MD.

Directed by Dr. David Rattner, the Natural Orifice Translumenal Endoscopic Surgery (NOTES) Laboratory develops innovative minimally invasive surgical procedures using the body’s natural orifices as entrance points for surgery to reduce pain and scarring and speed recovery time. The laboratory is supported in part by the Center for Integration of Medicine and Innovative Technology (CIMIT) and collaborates with physicians at several other institutions, including Brigham and Women’s Hospital and Dartmouth Medical Center.

Since 2009, the NOTES team has been investigating transvaginal cholecystectomy at Mass General as an alternative to conventional laparoscopic cholecystectomy to minimize the number of abdominal incision and reduce the amount of procedural pain. The procedures have been performed by Dr. David Rattner, Dr. Denise Gee, Dr. William Brugge and Dr. Samantha Pulliam.

In November 2009, Dr. Patricia Sylla traveled to Barcelona and, in collaboration with Dr. Antonio Lacy, performed the first surgical removal of a rectal mass using Transanal Endoscopic Microsurgery (TEM), a procedure in which surgical instruments were introduced through the anus to minimize the number and size of abdominal incisions.

• David Rattner, MD
• William Brugge, MD
• Denise Gee, MD
• Patricia Sylla, MD
• Samantha Pulliam, MD
• Alex Escalona, MD
• Abdulmetin Dursun, MD
• Katherine Briggs, BS

• NOTES transanal colorectal surgery
• NOTES transesophageal access to the mediastinum

1. Willingham FF, Gee DW, Lauwers GY, Brugge WR, Rattner DW. Natural orifice transesophageal mediastinoscopy and thoracoscopy. Surg Endosc. 2008 22(4):1042-7.
2. Gee DW, Willingham FF, Lauwers GY, Brugge WR, Rattner DW. Natural orifice transesophageal mediastinoscopy and thoracoscopy: a survival series in swine. Surg Endosc. 2008 22(10):2117-22.
3. Sylla P, Willingham FF, Sohn DK, Gee DW, Brugge WR, Rattner DW. NOTES Rectosigmoid resection using Transanal Endoscopic Microsurgery (TEM) with transgastric endoscopic assistance: A pilot study in swine. J Gastrointestinal Surgery 2008;12(10): 1717-23.
4. Willingham FF, Gee DW, Sylla P, Lauwers GY, Rattner DW, Brugge WR. En bloc esophageal mucosectomy for concentric circumferential mucosal resection. Gastrointest Endosc 2009; 69(1): 147-51.
5. Willingham FF, Gee DW, Sylla P, Kambadakone, A, Singh AK, Sahani D, Mino-Kenudson M, Rattner DW, Brugge WR. Natural orifice versus conventional laparoscopic distal pancreatectomy, a randomized controlled trial. Gastrointest Endosc 2009; 70(4): 740-7.
6. Gee DW, Rattner DW. Natural orifice translumenal endoscopic surgery: current status. Adv Surg. 2009;43:1-12.
7. Sohn DK, Turner BG, Gee DW, Willingham FF, Sylla P, Cizginer S, Konuk Y, Brugge WR, Rattner DW. Reducing the unexpectedly high rate of injuries caused by NOTES gastrotomy creation. Surg Endosc 2010; 24(2): 277-82.
8. Willingham FF, Turner BG, Gee DW, Cizginer S, Sohn DK, Sylla P, Kambadakone A, Sahani D, Mino-Kenudson M, Rattner DW, Brugge WR. Leaks and endoscopic assessment of break of integrity after NOTES gastrotomy: the LEAKING Study, a prospective, randomized, controlled trial. Gastrointest Endosc 2010; 71(6): 1018-24.
9. Sylla P, Rattner DW, Delgado S, Lacy AM. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 2010; 24(5): 1205-10.
10. Sylla P, Sohn DK, Cizginer S, Konuk Y, Turner BG, Gee DW, Willingham FF, Hsu M, Mino-Kenudson M, Brugge WR, Rattner DW. Survival study of natural orifice translumenal endoscopic surgery for rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assistance in a swine model. Surg Endosc 2010; 24(8):2022-30.
11. Turner BG, Cizginer S, Kim M, Kenudson MM, Sylla P, Rattner DW, Brugge WR, Gee DW. Endoscopic transesophageal mediastinal lymph node dissection and en bloc resection using mediastinal and thoracic approaches (with video). Gastrointest Endosc 2010; 71(1): 171-5.
12. Turner BG, Gee DW, Cizginer S, Konuk Y, Karaca C, Willingham F, Mino-Kenudson M, Morse C, Rattner DW, Brugge WR. Feasibility of endoscopic transesophageal thoracic sympathectomy (with video). Gastrointest Endosc. 2010 Jan;71(1):171-5.
13. Sylla P. NOTES in the Management of Colorectal Diseases: Current Experience and Future Directions of Completely NOTES Colorectal Resection. World J Gastrointest Surg 2010; 2(6): 193-8.
14. Turner BG, Cizginer S, Kim M, Mino-Kenudson M, Ducharme R, Surti V, Sylla P, Brugge WR, Rattner DW, Gee DW. Stent placement provides safe esophageal closure in thoracic NOTES procedures. 2010. Surg Endosc, in Press.

Natural Orifice Translumenal Endoscopic Surgery (NOTES) Laboratory

Email: psylla@partners.org

Please contact Patricia Sylla at psylla@partners.org.