Early Experience With Natural Orifice Trans-umbilical Surgery Gastric Bypass(notus) Using Needlescopic Instruments

We present our early data on NOTUS gastric bypass using needlescopic instruments and compare it to the traditional 5 port laparoscopic gastric bypass.

Prospective trial in which 20 morbidly obese patients after undergoing workup as per the NIH criteria were enrolled for NOTUS gastric bypass. Data collected included operative time, blood loss, hospital stay, periopererative complications, cosmetic appearance of incisions and patient satifaction surveys. This was compared with our own data of traditional 5 port laparoscopic gastric bypass. In brief NOTUS gastric bypass is performed by placing one 12 mm and one 5mm trocar through a single transumbilical incision followed by three needlescopic 2.3mm instruments introduced percutaneously in the left and right upper quadrants.

There were no differences between the two groups in terms of blood loss or hospital stay. There were no perioperative complications in either group. The operative times were slightly longer in the NOTUS group. Cosmesis was markedly improved in the NOTUS group. Patient satisfaction survey scores were also higher in the NOTUS group. 

In summary, NOTUS gastric bypass is a techically feasible procedure producing equivalent results as the traditional gastric bypass while achieving the cosmetic benefits desired of SILS.  Unlike SILS, it does not compromise the basic surgical tenets of precision and safety while still offering a potentially scarless operation.