Hybrid NOTES Transvaginal Sleeve Gastrectomy
Multi Disciplinary team of Doctors at the Asian Surgicentre Pvt.Ltd.,Ahmedabad(INDIA) have achieved what is believed to be the nation's first stomach reduction via the Vagina.The procedure was done by Dr.Narwaria(Bariatric Surgeon), Dr.Nilay Mehta (Gastroenterologist &Endoscopist) and Dr.Sanjay Patel/Dr.Yogendra Jhala (Endoscopic Gunecologist). Expanding on the scope of Natural Orifice Transluminal Endoscopic Surgery (NOTES), the current approach marks a crucial milestone in the field of minimally invasive surgery.
The medical team headed by Dr.Mahendra Narwaria, Director of Asian Surgicentre Pvt.Ltd.Ahmedabad, is actively engaged in the development and evaluation of such innovative techniques to provide better treatment options to patients, globally. We have performed sleeve gastrectomy through vagina for the first time in the country and Asia Pacific region.
Sleeve gastrectomy is a surgical weight loss procedure undertaken in patients affected with morbid obesity. The surgical removal of approximately 80% of the stomach, leaving a slender crescent-shaped stomach, induces early satiety and reduces food consumption, leading to a gradual weight loss in the treated patients.
A 45 year old female with a BMI of 41 kg/m2 was offered a Hybrid NOTES Sleeve Gastrectomy. After an informed consent of the patient we have decided to perform a combined transvaginal-transumbilical approach for a sleeve Gastrectomy . The procedure was carried out by a multidisciplinary team using a standard double-channel flexible videogastroscope and standard endoscopic instruments. At first, a 12 mm optic trocar was inserted through the umbilicus. A 12mm trocar was placed through the vagina through which endoscope was introduced and later through which specimen was retrieved. An additional 5mm trocar was placed in the right upper abdomen in mid axillary line. After dissection of the great curvature the sleeve resection was performed by endoscopic staplers (60mm).
The vaginal incision was closed by two stitches .The prospect of shorter hospital stay, lower chances of developing hernia, less pain, and better cosmetic acceptability of this procedure due to two tiny incisions, is expected to score over the laparoscopic approach, which requires five incisions for the surgery.
The transvaginal approach of Hybrid NOTES could make weight loss surgery more acceptable, and in turn contribute to minimizing the high level of morbidity and mortality associated with obesity.