tag:blogger.com,1999:blog-2760353953251845523.post4262387696876796259..comments2024-02-10T02:14:39.898-05:00Comments on Buckeye Surgeon: The NOTES beat drums louderJeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-2760353953251845523.post-19171799784182879282008-05-29T18:16:00.000-04:002008-05-29T18:16:00.000-04:00I had a tubal ligation about eight hours after the...I had a tubal ligation about eight hours after the birth of my seventh baby and my ob/gyn did it through a lap incision at my navel. That was in 1970. No post-op pain, no complications of any kind. And the scar disappeared completely within, I don't know...a couple of years? I would NEVER allow abdominable surgery THROUGH my vagina! Have those docs doing it offered appendectomies or whatever to men going up through their penises? I'll bet not!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-5101319025573653932008-04-28T22:31:00.000-04:002008-04-28T22:31:00.000-04:00er's mom, the thing that sticks out in my mind eve...er's mom, the thing that sticks out in my mind every time I read about this "route" is the possibility of causing sexual dysfunction. That would seem to me to be a rather serious side-effect which has gotta be far less likely with the traditional laparoscopy. I mean, I've heard of mothers complaining of pain during intercourse years after having their babies. (I won't know that particular "joy" because both of my babies were born via c-section, first due to fetal distress and second due to breech presentation during a TOLAC.) Wouldn't sexual dysfunction be a possible risk of this procedure?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-68348738142822991112008-04-12T05:26:00.000-04:002008-04-12T05:26:00.000-04:00nine years post grad! by that time i'd expect to b...nine years post grad! by that time i'd expect to be able to walk on water. hang on! they are internists. they will never walk on water! bwahaha.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-64916999856900919432008-04-11T10:02:00.001-04:002008-04-11T10:02:00.001-04:00? surgical training for a GI fellow. Give me a bre...? surgical training for a GI fellow. Give me a break. With all of the surgical fellows around these days, it's already hard enough to protect us (I'm a 4th year surgical resident). Where will this be done? OR or GI suite? Operating priveleges for gastroenterologists? I do believe NOTES has a role and that surgeons should lead the way. I've operated on enough peri-umbo incisional hernias from "uncomplicated" lap choles to know that even the simple day surgery lap chole doesn't mean the patient is out of the woods. It also may mean - reop for incisional hernia, mesh placement, infected mesh, etc. Curious how many CBD injuries it will take to make peope nervous about NOTES choles however.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-52607159203415678692008-04-11T10:02:00.000-04:002008-04-11T10:02:00.000-04:00? surgical training for a GI fellow. Give me a bre...? surgical training for a GI fellow. Give me a break. With all of the surgical fellows around these days, it's already hard enough to protect us (I'm a 4th year surgical resident). Where will this be done? OR or GI suite? Operating priveleges for gastroenterologists? I do believe NOTES has a role and that surgeons should lead the way. I've operated on enough peri-umbo incisional hernias from "uncomplicated" lap choles to know that even the simple day surgery lap chole doesn't mean the patient is out of the woods. It also may mean - reop for incisional hernia, mesh placement, infected mesh, etc. Curious how many CBD injuries it will take to make peope nervous about NOTES choles however.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-11712770310199132012008-04-11T08:07:00.000-04:002008-04-11T08:07:00.000-04:00As an Ob-Gyn, I think this is stupid and insane.Va...As an Ob-Gyn, I think this is stupid and insane.<BR/><BR/>Vaginal surgery is not as easy as people seem to think...closing that incision will be a bitch! And just wait until the post-op vaginal hematomas form. You can betcha I'm not going to care for them. And GI docs caring for it?<BR/><BR/>Vaginas have a vigorous blood supply...I can forsee a large blood loss. If I don't whipstitch the mucosa during my vag hysts, I routinely get a larger blood loss than my abdominal hysts. That's the way it goes, based on anatomy.<BR/><BR/>And just wait until they get a woman with bad endometriosis (unsuspected) or prior PID. I hate those cases open.<BR/><BR/>And, just out of curiosity, how DO they get all of the instruments and camera through 1 hole? I'm just thinking angles of access and mechanical considerations. I'm also thinking about those women who have deep vaginas, who would be a difficult vaginal surgery.<BR/><BR/>It all just sounds stupid, stupid, stupid. Laparoscopy is quick, minimally invasive (which is why I can't get around DaVinci hysts when we can do laparoscopic hysts), and most importantly, PEOPLE ARE TRAINED IN IT ALREADY!ER's Momhttps://www.blogger.com/profile/03203520439121823165noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-20457944736805026912008-04-10T21:50:00.000-04:002008-04-10T21:50:00.000-04:00That IS absurd. I think I'll take the incisions......That IS absurd. I think I'll take the incisions....<BR/><BR/><STRONG>You've been royally tagged by Mimi Queen of Memes. Have fun!<BR/></STRONG><A HREF="http://mimiwrites.blogspot.com/2008/04/mimis-message-in-bottle-meme-round-two.html" REL="nofollow"><STRONG>Message In a Bottle</STRONG></A>Mimi Lenoxhttps://www.blogger.com/profile/01616635898420835541noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-22932624404264008352008-04-10T20:34:00.000-04:002008-04-10T20:34:00.000-04:00Anon-I have heard the same rumor from a younger GI...Anon-<BR/>I have heard the same rumor from a younger GI pal of mine. There's a strong push from the GI community to get on board with NOTES early in the game. It would involve some sort of convoluted post-fellowship program where the Gi guy would do a year or two of "surgical training". Just watch where the enthusiasm for this nonsense is going to come from; GI bigwigs on the east coast, not necessarily surgeons.<BR/><BR/>Enrico-<BR/>Your post was good. More coherhent than my end of the day ramblings.<BR/><BR/>Alice- Good point about the wound infection issue. Of course it's a point that's just too obvious for the proponents to care about.Jeffrey Parks MD FACShttps://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-75000580041598973052008-04-10T19:42:00.000-04:002008-04-10T19:42:00.000-04:00I totally agree. If for no other reason, I really ...I totally agree. If for no other reason, I really cannot imagine patients preferring to have incisions and instruments put through these various orifices, rather than through tiny abdominal incisions. Also, wouldn't you think an incision through a traditionally contaminated area would lead to more intra-abdominal abscesses, despite any prepping? Currently we have qualms about even stapling across a prepped colon - let alone deliberately introducing instruments through it?!<BR/><BR/>And GI doing surgery? Haven't we already lost enough territory to interventional radiology and cardiology?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-52576624132242667442008-04-10T19:14:00.000-04:002008-04-10T19:14:00.000-04:00ha! I just posted about this very same article on ...ha! I just <A HREF="http://www.mexicomedstudent.com/2008/04/755" REL="nofollow">posted about this very same article on my site</A>, but of course, yours is more to the point and has better analogies (baseball). Good to know that even as a med student I wasn't far off the mark on how I read all of this.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-24206605282159979772008-04-10T14:34:00.000-04:002008-04-10T14:34:00.000-04:00Okay, how can appy by NOTES not be considered lapa...Okay, how can appy by NOTES not be considered laparoscopic surgery? How is the appendix visualized for dissection? Surely not but peering through an incised vagina? And, if so, how do you fit a scope and grasper/dissector/scissors and/or stapler all through one hole? I'd rather have an open appy than NOTES!make mine traumahttps://www.blogger.com/profile/18149160428613740527noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-10326391823912905702008-04-09T14:52:00.000-04:002008-04-09T14:52:00.000-04:00Does NOT gain footing (correction to my above comm...Does NOT gain footing (correction to my above comment)rlbateshttps://www.blogger.com/profile/15236331355857884458noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-1113698680441943382008-04-09T11:20:00.000-04:002008-04-09T11:20:00.000-04:00i agree with you. I hope NOTES does gain footing ...i agree with you. I hope NOTES does gain footing until they prove thenselves as more than being new.rlbateshttps://www.blogger.com/profile/15236331355857884458noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-31922366766210023202008-04-09T11:12:00.000-04:002008-04-09T11:12:00.000-04:00I had an interesting discussion with a third year ...I had an interesting discussion with a third year GI fellow regarding NOTES recently. Two items in the conversation stood out:<BR/>1- When asked if he thought there was any real advantage to using NOTES, he stated that he recently attended a conference at a major NY academic center where they presented evidence that NOTES causes less hemodynamic compromise under general anesthesia than would laparoscopy. Therefore this may be a preferred method for those with substantial co-morbidities (CAD, CHF, COPD, etc) who are at high-risk for laparoscopy.<BR/>Two- this particular medicine doctor is very interested in becoming involved with performing NOTES. He is currently finishing his third and last year of GI fellowship, will be doing a GI interventional fellowship next year at a major NY academic center (ERCP), and then will be doing two years of surgical training to become proficient with NOTES. He states that this is the model the medicine/GI docs are seeking to adapt for NOTES training.<BR/>My reactions: <BR/>1- I would like to see the evidence he claims.<BR/>2- Seems a bit inefficient to undergo NINE years of post-grad training (3 of int med, 3 of GI, 1 interventional, 2 'surgery') so that you can do a procedure most second year surgery residents should feel comfortable with (appy and chole).<BR/>I agree with everything in your post. Just sharing the info.Anonymousnoreply@blogger.com