In the old days, one could refine surgical technique with just sutures and a board of styrofoam. Now, in order to learn laparoscopy, interns and residents have to use super-expensive simulators to which most hospitals don’t even have access. So even though laparoscopy is known to offer many advantages over open procedures, many surgeons still don’t feel comfortable with it. The problem isn’t, of course, that laparoscopy itself is hard, but that getting decent practice is so difficult. 

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The lower esophageal sphincter is a bothersome little junction that so often fails to do its job: either it’s too loose and burps up hot acid after each meal, or it’s too tight and won’t let anything down. Although we jam all sorts of devices down there to determine the need for surgical intervention, it’s hard to get a clear picture of the entire sphincter’s behavior. The EndoFlip is a new device that was shown off at the emerging technologies session of SAGES 2008 and is claimed to make measurements of LES tone much more accurate and informative.

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At SAGES we got the distinct impression that every surgical procedure known to man has a one-way ticket to NOTESville. If that’s the case, then surgeons will need to get a lot more comfortable manipulating endoscopes, as their unintuitive controls tend to frighten novices. We stopped over at the Simbionix booth to check out their GI Mentor II endoscopy simulator, and Rob Kurtzner, the onsite sales exec, gave us a tour of its features. Check out the video after the jump.

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Despite all of the breathless praise being heaped on NOTES at this year’s SAGES, there was still considerable excitement about single port access laparoscopy, another kind of über-minimally invasive surgery that has made great strides over the past year. In this two-part series, we’ll take a look at some of the devices that have made this platform possible.

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The exhibit hall at SAGES 2008 was something of an HD wonderland; everywhere you turned, there was another laparoscope pointing at a flower, the minute stalks of the stamen revealed in excruciating detail on a nearby flatscreen.

Of all the high definition systems shown, we must say that we were the least impressed with the optics from Olympus’s cameras. Their laparoscopes produced images that were really not much better than standard definition, not to mention that theirs is the only camera that doesn’t have a 16:9 aspect ratio. With that being said, the new Olympus recorder ain’t half bad.

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What they were looking for; what they should have been looking for. 

Finding it increasingly difficult to figure out the latest high-tech gadgets at Best Buy? Dr. Thomas Krummel has little sympathy for you. In the annual Karl Storz Lecture, Dr. Krummel addressed the problem of surgeons innovating in an increasingly technological world. 

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Surgeons don’t usually spend too much time worrying about the closure of trocar site incisions, but if the name of your game is speed, or if you find that patients wake up just a bit too quickly during suturing, then NeatStitch is your tool.

The device is inserted in the trocar, and then two blunt needles are deployed at the tip. The needles are pulled toward the body wall and then, with the press of a button, are rapidly driven through the fascia. The sutures can then be cut from the device and tied.

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During the SAGES emerging technologies session, which to us was like an early Christmas, Dr. Dmitry Nepomnayshy presented his experience using the EndoBarrier, an endoscopically-deployed impermeable tube that is placed in the duodenum to prevent absorption.

Two patients have received the full treatment so far; within twelve weeks, one lost 11 pounds and the other 26 pounds. Neither reported making crinkly plastic wrapper sounds upon leaning forward. [ → read more ]

Sometimes a long trocar is a good thing: when your patient has a BMI of 40, for example, there will be a fair amount of abdominal fat to plow through. Sometimes, however, a long trocar is not so desirable: when you have just driven it into the aorta, say, or when it starts bumping into neighboring trocars or instruments during procedures.

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