Wednesday, October 22, 2008

Surgery without scalpels?

New surgery technique offers the possibility of healing patients without scars

It may sound like science fiction, but the possibility of surgery that can be completed without a scar may soon be a reality.

The Massachusetts General Hospital Digestive Healthcare Center is at the forefront of investigations into natural orifice transluminal endoscopic surgery, more commonly known as NOTES. This breakthrough means “scarless” abdominal operations can now be performed with an endoscope passed through a natural orifice (mouth, urethra, anus), and then through an internal incision in the stomach, bladder or colon. The technique avoids any external incisions or scars.  

David Rattner, MD, chief of the Division of General and Gastrointestinal Surgery at Massachusetts General Hospital, and the leader of a national coalition of doctors interested in NOTES, is heading up a Boston-based team that is researching the approach. The other local doctors involved include William Brugge, MD, (MGH), Christopher Thompson, MD, MS, (Brigham) and Richard Rothstein, MD, (Dartmouth).

The group recently received an important vote of confidence in the form of a $2.1 million award from the Center for Integration of Medicine and Innovative Technology (CIMIT). CIMIT, a non-profit consortium of Boston-area teaching hospitals and engineering schools co-founded by Dr. Rattner, praised the possibilities offered by procedures that are scarless and less painful for patients, and which cost less for hospitals to perform. Representatives of the agency expressed particular enthusiasm for Dr. Rattner’s contribution to ongoing research in the form of procedures previously thought impossible.

The award will allow for the emerging technique to be further developed and performed on more humans. The procedure has been utilized in treating about 400 patients worldwide, largely in South America and India. Only about 40 patients in the U.S. have undergone surgeries using NOTES so far. "More research and a greater number of carefully planned human trials must be done," says Rattner. "I can say NOTES has great potential to help patients."

The ongoing initiative exemplifies how the Massachusetts General Hospital Digestive Healthcare Center and other leading institutions worldwide share knowledge and expertise to more quickly develop procedures that can dramatically improve their patients’ quality of life. This collaborative approach to research is in keeping with Mass General’s commitment to its international reach, as expressed in its mission statement to serve the "local and global community." And NOTES does have great potential to benefit patients around the world. “Because NOTES may eventually be performed in austere, non-sterile conditions, it could be a valuable new approach in developing countries as well,” says John Parrish, the Executive Director of CIMIT.

Such tangible global significance shows that surgery without scalpels is not a science fiction fantasy. Rather, NOTES is soon to be a reality for patients everywhere. And it is another clear example of Mass General’s commitment to remaining on the forefront of medical advances, as exemplified by the work the Digestive Healthcare Center is doing to maintain its ongoing position as a dynamic leader in its field.

Back to Top