Surgical Innovations 2007
In recent years, rapidly emerging technologies and improved techniques have brought minimally invasive endoscopic surgery closer to a once-elusive goal: incisionless surgery.
At the forefront of this trend, Columbia and Weill Cornell physicians at NewYork-Presbyterian Hospital have been developing NOTES™ (natural orifice translumenal endoscopic surgery) in both research and clinical settings.
Mathew R. Williams, MD
Intricate repairs to the heart can now be performed through flexible catheters threaded into blood vessels in the groin or arm.
In comparison to open surgery, catheter techniques can mean less pain and faster recovery for patients.
Mathew R.Williams, MD, Surgical Director, Cardiovascular Transcatheter Therapies chose to pursue both paths so that he could "combine the best of both worlds."
As the first U.S. physician to have joint training and appointments in interventional cardiology (the field that employs catheter technques) and cardiac surgery, Dr. Williams performs an increasing number of what he calls "hybrid" procedures procedures that use the best of both surgical and less invasive methods to achieve optimal solutions.
Incisionless Surgery with Natural Orifice Techniques
Natural Orifice Translumenal Endoscopic Surgery, or NOTES, is a new method of performing minimally invasive surgery through the mouth, anus, or vagina.
Drs. Marc Bessler, Peter Stevens and Dennis Fowler have successfully performed the first U.S. transvaginal gall bladder removal operation (cholecystectomy) with limited laparoscopic assistance as part of a larger IRB approved study.
In addition to transvaginal removal of the gallbladder, the Columbia team is conducting minimally invasive procedures for appendectomy, gastroesophageal reflux, and weight loss surgery.
Congenital diaphragmatic hernia, or CDH, is one of the most common birth defects, affecting about one in 3000-4000 newborns today.
Among babies with CDH, pulmonary hypertension can lead to heart failure and is the most significant cause of illness and death.
Fortunately, medicine has made tremendous progress against pulmonary hypertension during the past 25 years.
The 'David' aortic root repair procedure for aneurysms of the ascending aorta preserves and rebuilds the patient's own aortic valve, avoiding the disadvantages of valve replacement.
At NewYork-Presbyterian Hospital/Columbia, results have been excellent among the 50-plus David procedure operations performed since 2005, with 100% short-term success.
Read more about how Aortic Aneurysm Surgery Preserves Patients' Valves.
Until recently, many patients with precancerous growths or early cancers of the rectum had to undergo open surgery with a long recovery period and risks of complications.
Now, a new addition to the surgeon's toolkit, transanal endoscopic microsurgery (TEMS), can eliminate the need for major surgery for many of these patients.
James Guarrera, MD
As advanced as the field of organ transplantation has become, several important challenges remain. Of these, the availability of donor organs stands paramount.
Among those with end stage liver disease, over 17,000 patients wait for a donated liver every year in the U.S., but fewer than 6000 receive one, and about 1800 people die while on the waiting list.
As a result, researchers are avidly working to find ways to safely use as many potential donor organs as possible, including organs that once may have been considered "imperfect."
For patients with advanced melanoma and kidney cancer, traditional therapies such as surgery, chemotherapy, and radiation simply may not be enough.
Immunotherapy is a new, systemic approach that harnesses the body's natural immune system in its fight against the deadly cells and can dramatically reduce tumors in patients with melanoma and kidney cancer.
The Interleukin-2 Unit of the New York-Presbyterian Tumor Immunotherapy Program at Columbia University Medical Center uses interleukin-2, or IL-2, to treat patients who have malignant melanoma and advanced kidney cancer.
IL-2 represents one of the best treatment options for patients with advanced melanoma and kidney cancer.
Columbia Physicians Perform First U.S. Transvaginal Cholecystectomy
Marc Bessler, MD
On March 20, 2007, Drs. Marc Bessler, Peter Stevens and Dennis Fowler successfully performed the first U.S. transvaginal gall bladder removal operation (cholecystectomy) with limited laparoscopic assistance as part of a larger IRB approved study.
The transvaginal surgical approach enables access to the abdominal cavity with minimal or no external incisions or scars. In this first procedure, only three tiny laparoscopic incisions were made as compared to the customary four substantially larger incisions needed for a traditional laparoscopic cholecystectomy.
"The patient felt almost no pain on recovery, other than some minor discomfort at one laparoscopic site.
We believe this approach will provide patients the benefit of reduced pain, faster recovery time and fewer scars than the traditional laparoscopic alternative," said Dr. Stevens, who is Director of Endoscopy at NewYork-Presbyterian Hospital/Columbia University Medical Center. "As we enroll additional patients and gain experience with this technique we expect to reduce the number of laparoscopic ports—with the goal of a true incisionless procedure," said Dr. Bessler.
The operation was covered in an April 20, 2007 New York Times feature about the surgical technique, known as natural orifice translumenal endoscopic surgery, or NOTES. The groundbreaking operation was also featured in United Press International (April 20) and ABCNews.com (April 23).