First human NOTES experience for sleeve gastrectomy at UCSD

Sleeve gastrectomy, in which part of the stomach is removed, can be safe and effective when performed either transorally or transvaginally, according to researchers at the University of California, San Diego (UCSD) who are pioneering the surgery in the U.S.

Natural orifice translumenal surgery® (NOTES) eliminates the need for a large incision for organ removal, which could increase risks for infection, incisional hernia and other problems. In their review of 14 morbidly obese patients who had undergone NOTES as part of a gastrectomy, the researchers found no complications. Hospital stays averaged two days.

"In experienced hands, this is a viable option for the popular laparoscopic sleeve gastrectomy," said Garth Jacobsen, MD, director of clinical operations at the UCSD center for the future of surgery.

Noted Sheetal Nijhawan, MD, of the UCSD department of surgery, "The procedure is further evidence that it is possible to safely remove sizable organs from the abdominal cavity in both men and women without leaving large scars on the abdominal wall."

Patients involved in the multi-year study included 12 women and two men whose pre-operative body mass index was 46.1. Nearly three-quarters had high blood pressure and 42 percent had diabetes, osteoarthritis or high cholesterol.

Researchers are now moving toward a purely NOTES protocol for morbid obesity, with the knowledge gleaned from their surgical experience applicable to other operations, Dr. Nijhawan said.