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Last Updated: Wednesday, 7 July, 2004, 23:13 GMT 00:13 UK
Surgery without a cut to the skin
A new technique might allow surgeons to operate on internal organs without making any cuts in the skin, say US researchers.

The Johns Hopkins University team says a mini-telescope could go down the throat and make a cut in the stomach wall to reach abdominal organs.

The technique, tested in pigs, could mean faster recovery times say the authors in Gastrointestinal Endoscopy.

But UK surgeons said the method was riskier than current techniques.

TRANSGASTRIC PERITONEOSCOPY
1) Endoscope carries incision tools
2) Surgeon makes cut to access abdominal cavity

Traditionally, when surgeons wanted to see what was going on inside the abdomen they would make a large cut through the skin and wall of the stomach - the abdominal wall.

Surgeons have developed less invasive methods such as key hole surgery or laparoscopy.

Here a flexible, mini-telescope is inserted into the abdominal cavity through a small cut in the abdominal wall, measuring as little as 2mm in diameter.

Now Dr Anthony Kalloo and his colleagues believe it may be possible to get to abdominal organs such as the bowel, liver, gall bladder and pancreas via the stomach.

In experiments on pigs, they were able to pass an endoscope down the throat and into the stomach.

They made a cut in the stomach and passed the endoscope through the stomach wall and into the abdominal cavity.

They believe this method, called flexible transgastric peritoneoscopy, will allow patients to heal more quickly after surgery.

Quicker recovery

Dr Kalloo said: "The technique is less invasive than even laparoscopy because we don't have to cut through the skin and the muscle of the abdomen.

"Because the lining of the stomach repairs faster than skin, recovery times should be reduced."

But UK surgical experts were worried about the safety of the new technique.

David Rosin, vice president of the Royal College of Surgeons of England, said: "It's fascinating and innovative but it's fraught with dangers.

"You could cause peritonitis [inflammation of the abdominal wall lining that can be fatal] from the acid in the stomach being let loose.

"The light that is used from an endoscope at the moment is really quite hot and going through the stomach could be dangerous. It could burn.

"Laparoscopy is doing exactly the same - visualising the internal organs - but it has proved to be really safe and sensible.

Dangers

"There are more dangers going through the stomach than doing laparoscopy," he said.

Rory McCloy, consultant surgeon at Manchester Royal Infirmary and member of the British Society of Gastroenterology, echoed Mr Rosin's concerns.

"The problem I have is the inside of the stomach is potentially dirty. You are perforating through a dirty area into the clean abdominal cavity. That could cause peritonitis.

"You would have to seal up the hole you have made in the stomach as you come out and make sure that the hole does not leak.

"I can't see any advantages, just disadvantages.

"It makes a meal of something we do readily thousands of times in the UK through a perfectly better route which is through your skin and tummy wall," he said.




SEE ALSO:
Keyhole cancer surgery effective
14 May 04  |  Health
Keyhole system 'a major advance'
01 Mar 04  |  Scotland


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