Endoscope: Less invasive alternative to laparoscopic techniques or conventional surgery

Mayo ClinicOct 15 2009

Clinical trial may be in near future

Mayo Clinic surgical researchers are reporting a 93 percent success rate in recent animal tests of endoscopic repair of perforated ulcers. The goal is to advance the use of an endoscope -- which allows access to organs through natural openings, such as the mouth -- for a less invasive alternative to laparoscopic techniques (surgery performed through a small incision) or conventional surgery. They will present their findings from recent animal studies today at the American College of Surgeons 95th Clinical Congress in Chicago.

"Laparoscopic surgery for this condition is only 80 percent successful for a variety of reasons," says Juliane Bingener, M.D., senior author on the study. "In our laboratory experiments we were over 90% successful. We also hope to ultimately reduce the risk to the patient overall and reduce postoperative complications."

The process is called natural orifice translumenal endoscopic surgery (NOTES). The goal is to ultimately limit the physiological impact on the patient. While endoscopic repair limits the level of anesthesia used, in the distant future, it may be done without anesthesia, thus limiting one possible procedural side effect.

"Laparoscopy is great, but not all surgeons do it. It's not easy to do. It's technically advanced," says Erica Moran, M.D., Mayo surgeon and researcher. "But it's already been shown that there are many benefits if we can do noninvasive procedures with people who are actually quite ill."

The researchers are seeking regulatory approval to begin a human clinical trial using the technique in the near future. The advantages of NOTES for ulcer repair:

• No surgical incision
• Less discomfort for patient than laparoscopy -- 50 percent less air is introduced into the body
• Shorter recovery time than conventional surgery
• Provides ulcer-repair option for candidates too ill for conventional surgery

The doctors emphasize that the endoscopic approach may not be appropriate for all cases. Each patient's background symptoms and other medical conditions would need to be considered in determining which approach to use.