Natural Orifice Surgery

Dr. Marc Bessler is assistant professor of surgery at Columbia University College of Physicians and Surgeons, and director of the Columbia University Center for Metabolic and Weight Loss Surgery. He is also the director of the Minimal Access Surgery Center at New York-Presbyterian Hospital/Columbia University Medical Center. A fellow of the American College of Surgeons, Dr. Bessler's clinical specialties include surgical management of morbid obesity, gastroesophageal reflux disease, laparoscopic surgery of the stomach, esophagus and hernia surgery, and natural orifice surgery. His research interests focus on hormonal, oncologic, and immune responses in laparoscopy.

He earned his medical degree from New York University School of Medicine, and completed his residency in general surgery and his fellowship in surgical endoscopy at the Columbia University College of Physicians and Surgeons and the Presbyterian Hospital in New York City.

  • Transcript

TRANSCRIPT

Marc Bessler: Well I’m a minimalist or minimally invasive surgeon if you will, I try and do everything with the least trauma to the patient. Laparoscopy, doing things with small incisions and scopes has been sort of for the past 15 years or so, the way we’ve done that and we’re trying to take that to the next level. If we can do surgery without external scars, if we can do surgery without pain and surgery without maybe a significant recovery period, we’ve taken that to the next level of minimally invasive. There’s this whole area now of natural orifice surgery, trying to do surgery through a natural orifice, not having to make a new cut, going through an organ that doesn’t feel pain the same way as skin and muscle feels pain to accomplish the goal and it’s a burgeoning or really emerging area. Right now you can have your heart instead of open heart surgery, you can have something done through your blood vessels to open up a blood vessel right. You can have your aneurism fixed by going through your artery to put a stent into your aneurism and what we’re trying to do is bring that same thing to abdominal surgery, no incisions, no pain, very quick recovery. We decided to take the approach of going behind the uterus, not to go through the stomach or the colon because it was a safer approach we believe, it’s an area that we can sterilize, it’s an area that isn’t gonna leak bacteria or things into the abdominal cavity. To prove the point that if we didn’t make incisions in someone’s abdomen to remove their gallbladder as one example that they wouldn’t have pain, they would recover more quickly and therefore this is a worthwhile thing to pursue even in people who don’t have a uterus to go behind but that we would have to go through the stomach or the rectum. We performed one of the world’s first gallbladder operations that way. As a matter of fact two weeks ago we performed the first one with no external needles, incisions or anything, everything done through the natural orifice and that was transvaginal and around the world I know of about 250 or so operations that have been done this way and it does seem like patients have dramatically less pain and much quicker recovery. We still have to get to the point where we prove I think this in a larger series of patients but I think it is emerging. Gallbladder’s not the only thing, appendix has been done that way, some obesity surgery is starting to be done that way, we can remove portions of someone’s stomach that way and I think many more choices of operations are going to be coming, once we prove that this is valuable. Technology needs to advance in order to make this better and work for other these operations, an industry has to believe that this is coming in order to buy into that and invest in that technology but I think that’s gonna be coming.

 

Recorded on: 6/16/08


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