The First Surgeon to Remove a Gallbladder Via the Mouth Joins Virtual Ports

Natural-Orifice Translumenal Endoscopic Surgery (NOTES) is an innovative method of abdominal surgery that does not involve an incision in the abdominal wall.

In the 1980s, a method of abdominal surgery was developed that does not require large incisions in the abdominal wall; instead, a camera and surgical instruments are inserted through tiny channels. This method, known as laparoscopy, is a kind of minimally invasive or endoscopic surgery.

Laparoscopic surgery, in which doctors insert surgical instruments into the abdominal cavity through orifices, revolutionized abdominal surgery and made recovery much quicker than with open (regular) surgery. Some 5 million laparoscopic procedures are now performed around the world each year.

Natural-orifice translumenal endoscopic surgery (NOTES) is an innovative method of abdominal surgery that does not involve an incision in the abdominal wall. The operation is performed through natural orifices such as the mouth. The surgeon passes the camera and surgical instruments into the stomach and, from there, into the abdominal cavity through an incision in the stomach lining. The entire operation uses only one channel (as opposed to several channels in laparoscopic surgery), and is therefore extremely challenging for surgeons.

NOTES is another step forward in abdominal surgery. Its advantages are obvious: faster recovery, no scarring or unaesthetic marring of the abdominal wall, and less pain (the incision is in the stomach lining, which is less sensitive than the stomach muscles). In the future it may even be possible to perform the operations under sedation rather than general anesthesia.

Some people believe that this innovative technique is currently where laparoscopy was 20 years ago, and that in the future more and more operations will be done without incisions in the abdominal wall.

Virtual Ports, Ltd. (, which specializes in developing instruments for laparoscopic surgery in the abdominal cavity, reported this week that Dr. Lee Swanstrom has joined the company’s scientific advisory board. Dr. Swanstrom, director of minimally invasive surgery at Legacy Medical Center in Portland, Oregon, is one of the developers of the NOTES technique. Last June he performed the first gallbladder removal from a human being via the mouth without an incision in the abdominal wall.

According to Dr. Swanstrom, the Virtual Ports retraction system is needed in NOTES. Especially important is the EndoGrabTM device developed by Virtual Ports for retracting internal organs for laparoscopic procedures. The device will make procedures easier for surgeons and will offer them new opportunities for the challenging NOTES operations.

EndoGrab was invented by Virtual Ports for use in laparoscopic surgery and received FDA clearance for marketing earlier this year. The company plans to produce a version of the instrument for NOTES operations as well.

The CEO of Virtual Ports, Udi Gordin, reports that the company is pleased to have the opportunity to work with Dr. Swanstrom in this constitutive period for the NOTES technology and to be involved in the creation and development of new, advanced surgical techniques that are less dangerous and present substantial advantages to patients.

About Dr. Lee Swanstrom

Dr. Swanstrom is head of the surgery department at Legacy Emanuel and Good Samaritan hospitals in Portland, Oregon. His primary clinical focus is the development of advanced laparoscopic procedures. Dr. Swanstrom has published more than 40 papers and edited three books, and he is a world renowned researcher and innovator in the field of minimally invasive surgery.

For further information, please contact:

Nir Frider, Galil Communications

Natural-Orifice Translumenal Endoscopic Surgery


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