Clinical Experience with a Multifunctional Flexible Surgery System for Endoluminal, Singe Port and NOTES Procedures

Introduction: Single port and incisionless surgical approaches hold the promise of fewer complications, reduced pain, faster recovery and improved cosmesis compared to traditional open or laparoscopic ones. The ability to select an access approach (i.e., endolumenal, single port, trans-vaginal or trans-gastric) with one platform may be important to optimizing individual patient results.
We report our results utilizing these 4 separate surgical approaches tailored to 3 different therapeutic procedures, all with use of a single flexible platform (EndoSurgical Operating SystemTM (EOS)).
Methods: Following IRB approval, the EOS was used to perform 9 cholecystectomies (trans-vaginal (TV) access, n=4; trans-gastric (TG) access, n=4; single port trans-umbilical (TU) access, n=1)); 2 appendectomies (TG access, n=2); and 18 gastric pouch and stoma reductions in post-Roux-En-Y gastric bypass (RYGB) patients (endolumenal (E) access). TG and TV procedures included use of 1-3 trocars. Recorded data included safety, procedural success, operative time, patient pain assessment at discharge (0-10 scale), and length of hospitalization.
Results: Procedural success was achieved for 16/18 endolumenal, 1/1 single port and 10/10 NOTES procedures. 5/10 NOTES procedures only required use of 1 small trocar. Mean operative times were 79 mins. for pouch + stoma reduction, 171 mins. for cholecystectomy and 274 mins. for appendectomy. 27/29 patients were discharged in < 24 hours. Average pain scores were .44 (pouch + stoma reduction), 1.3 (cholecystectomy) and 2.5 (appendectomy). There were no significant complications. The EOS ergonomics allowed the surgeon to interface with the system using an endoscopic and/or laparoscopic orientation.
Conclusions: Availability of a multifunctional, flexible surgery platform provides a choice of single port or incisionless surgical approaches with the potential to reduce complications, pain, and recovery time while improving cosmesis.

Session: Podium Presentation

Program Number: S084

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