Friday, June 5, 2009

NOTES: Bringing a surgical revolution to MGH


In an MGH milestone, surgeon David Rattner, MD, chief of the Division of Gastrointestinal and General Surgery, and his team performed New England's first natural orifice surgery, leaving no visible scar and resulting in minimal postoperative pain. The procedure, which is called NOTES – natural orifice translumenal endoscopic surgery – involves passing a flexible endoscope as well as surgical instruments through a natural orifice, such as the mouth, anus or vagina, to the destination surgical site. In the MGH procedure, performed May 20, a patient's gallbladder was removed via her vagina. The surgery went smoothly, and the patient -- a mother of four -- was able to resume her busy daily activities within four days.

"NOTES has the potential to revolutionize the way some operations are conducted," says Rattner. "In minimally invasive laparoscopic surgery, the instruments are passed into the body via tiny incisions. These incisions through the abdominal or chest wall still cause pain and can delay recovery. By using a natural orifice as the entry point for surgical tools and the route for removing organs that are resected, pain is avoided, potentially resulting in a faster recovery."

At this stage, the NOTES procedure is still experimental. Ongoing studies will focus on refining instruments for the procedures and safe and effective methods of closing the internal access site.

"Based on our first case, as well as others I have been involved with at collaborating sites around the world, I am encouraged that one day we will be able to help patients get back to their normal lives more quickly and with less postoperative pain," says Rattner.

Members of the MGH NOTES team include William Brugge, MD; Marie Egan, RN; Denise Gee, MD; Maureen Hemingway, RN; Samantha Pulliam, MD; Shauna Ring, CRNA; and Torrin Shear, MD. The NOTES team is supported by the Center for Integration of Medical and Innovative Technology (CIMIT), which selected NOTES as its inaugural Strategic Project Grant recipient several months ago, providing $1.5 million over three years to further develop the technique.

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