Surgeries performed with specialized medical devices requiring only small incisions, called laparoscopic surgery, have many advantages over traditional open surgery, including less pain, fewer complications and quicker recoveries. Now, scientists at Johns Hopkins have created a new surgical technique that in extensive animal studies is safe and may improve even further the benefit of minimally invasive surgery by leaving the abdominal wall intact.
The new procedure, called flexible transgastric peritoneoscopy, or FTP, is performed by inserting a flexible mini-telescope, called an endoscope, and related surgical tools, through the mouth and into the stomach. After puncturing the stomach wall and the thin membrane surrounding the stomach -- called the peritoneum, which also lines the inside of the abdominal and pelvic cavities -- the doctors can see and repair any of the abdominal organs, such as the intestines, liver, pancreas, gallbladder and uterus.
"FTP may dramatically change the way we practice surgery," said Anthony Kalloo, M.D., associate professor of medicine and director of gastrointestinal endoscopy at Johns Hopkins and lead author of a report describing the new procedure in the July issue of Gastrointestinal Endoscopy. "The technique is less invasive than even laparoscopy because we don't have to cut through the skin and muscle of the abdomen, and it may prove a viable alternate to existing surgical procedures."
For their study, the investigators relied on standard endoscopic equipment already in use, but they are awaiting development of even better, specialized equipment before they begin clinical trials on humans, sometime within the next year. The researchers, including an international think-tank group of gastroenterologists from five universities called the Apollo Group, have already designed an endoscopic sewing machine to close incisions.
The researchers first evaluated the technical feasibility and safety of the procedure by performing liver biopsy on pigs under general anesthesia. After washing the stomach with an antibacterial solution to prevent infection, a small incision was made to allow access to the peritoneal cavity. The cavity was then filled with air to increase the visibility of the organs, biopsy samples were taken from the liver, and the incision was sealed with clips. The pigs were monitored for 14 days following the procedure and showed no signs of serious infection or other complications, and the surgical site was completely healed.
"Because the lining of the stomach repairs faster than skin, recovery times should be reduced," says Kalloo. Ironically perhaps, while a surgical injury to the lining of the stomach or intestines is often considered a serious medical condition because of the risk of infection, the results of this study show that careful preparation and monitoring can turn a potentially fatal situation into a better and safe surgical technique, adds Kalloo.
In a second study, the researchers evaluated the safety of the new surgery for blocking the Fallopian tubes, or tubal ligation -- an immediately effective, permanent form of female birth control that works by preventing an egg from traveling from the ovary to the uterus. All five pigs that underwent the 20-minute procedure recovered well without ill effects or any abdominal scars, and the fallopian tubes remained completely blocked.
Other investigators in this research are Sergey Kantsevoy, Sanjay Jagannath, Cheryl Vaughn, Diana Scorpio, Carolyn Magee, Laurie Pipitone, Vikesh Singh, Hideaki Niiyama and Susan Hill. In addition to Kalloo, members of the Apollo group are: Sydney Chung, Chinese University of Hong Kong; Christopher Gostout, Mayo Clinic; Peter Cotton and Robert Hawes, Medical University of South Carolina; Jay Pasricha, University of Texas Medical Branch Galveston; and Sergey Kantsevoy of Johns Hopkins.
Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Anthony N. Kalloo et al. July 2004. Gastrointestinal Endoscopy, Vol. 59, No. 8.
Per-Oral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Sergey V. Kantsevoy et al. May 2004. Digestive Disease Week presentation at the American Society for Gastrointestinal Endoscopy annual meetings. New Orleans, La.
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