Congress presents transvaginal pancreatic resection

Advanced endoscopes have already transformed certain surgical procedures. Thanks to minimally invasive surgery (MIS), such as NOTES (Natural Orifice Translumental Endoscopic Surgery), even bowel resection can be relatively scar-less. Such procedures are entering gastroenterology, as presented at the 40th Congress of the German Society of Endoscopy this March.

This year’s congress president, gastroenterologist Professor Jürgen Hochberger, director of the Medical Clinic III at St. Bernward Hospital, Hildesheim, discussed developments with EH Managing Editor Meike Lerner:

‘Gastroenterologists have so far been a little cautious about the use of NOTES. At the congress the first experimental approaches, such as a transvaginal pancreatic resection in a pig, were carried out live -- in partnership with the Federal Research Institute for Animal Health -- with great interest and success. It will certainly take some further developments in equipment before these interventions become possible for humans. However, over the last few years our experience has taught us that these surgical innovations have also been very productive for our field. The Bear-trap, along with other, novel coagulation forceps, is an example of this. The bear-trap is an “over-the-scope-clip” that is ejected through a novel mechanism by the end of an endoscope to cover a sutural insufficiency, or a resection defect – a huge progress for our daily work. With the help of new coagulation forceps we can now also coagulate much thicker vessels, in laparoscopic as well as endoscopic applications. Thanks to these developments, the endoscopic coagulation of the splenic vein, via NOTES, is feasible in the future.

Endoscopic submucosal dissection (ESD)

‘Flexible resection procedures represent an enormous progress in our daily clinical work. A good example is the case of a patient in our clinic who had an 11cm x 7cm change in the rectum removed endoscopically. In this particular case, the mucous membrane, over 90% of the wall circumference, was completely resected – without complications. Only a few years ago this patient would have been a case for the surgeon, resulting in him being given a stoma. We were able to spare the man this fate.

‘An important point that goes along with all these advances in the field of flexible endoscopy is training in the new procedures, which have now become so complex that years of experience is required. In my view, a separate discipline will establish itself in the medium term – a combination in training for surgery and gastroenterology.

Coloscopy using a colon capsule

‘The data available in this field is not yet very comprehensive – but the existing findings are very promising. A new generation of capsules has cameras on both sides – with a really brilliant resolution and energy-saving rest phases when the capsule remains in one location. The easy handling – for the patient as well – and good sensitivity compared to the guaiac test could even qualify colon capsules as a suitable screening procedure for bowel cancer. This is a development I am very excited about.’


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