During my GI fellowship (2007 to 2010), The concept of NOTES surgery was introduced with lots of enthusiasm. With exception to POEM procedure, enthusiasm to other NOTES application quickly faded. This was mainly due to the lack of robust closure devices and inability to triangulate with endoscopy. Recently, the introduction of excellent approximation and closure devices allowed us to venture into NOTES world again. @KeihanianTara detailed the first western experience from Baylor St Lukes Medical Center in performing transcecal appendectomy using NOTES technique in 9 patients with colonic adenoma invading inside appendiceal lumen. Few take home points about our case series.
* This is a pure NOTES technique in which colonoscope is advanced into peritoneal cavity to dissect the entire appendix from mesoappendix
* This technique is limited to benign TA or SSA invading deeply into appendceal lumen. The technique should not be performed for malignant lesions or mucinous appendiceal tumor to avoid peritoneal contamination.
* why this technique over EFTR? no size limitation and no risk of stump appendicitis and it ensure R0 resection in lesions extending deeply into appendix
* The alternative to this technique in these subset of patients is right hemicolectomy ( not appendectomy) since these lesion are involving the cecum too.
* CT scan is important prior to performing this technique to determine the length of the appendix ( varies from 3 to 18 cm) and to rule out any mass or advanced lesion
* The use of traction devices and stabilization devices made our experience unique from the previously published series from the East and expedited the dissection! #AmericanESD
https://t.co/f2qj5n6kzl
The 1️⃣#AEF fellow to graduate at @MountSinaiNYC#MSSN — our 🐦 has left the nest!
We are so proud of you Pranay @PranayS88 & excited to see all the amazing things you will continue to achieve. You will always have a 🏠 w/ us! @frank_gress
Welcoming our new #AEF#SadatIqbal
Congrats to our advanced endoscopy fellow Pranay Srivastava @PranayS88 on your graduation! All the best as you begin the next phase of your career!
Our team @MS_SouthNassau will miss you!
“With these assault weapons, not only do you have more bullet wounds but the caliber of those wounds is often greater... In a child, all the vital organs are that much closer together. So each of the bullets causes irreversible damage.” --@drchethansathya
My fellows doctors and healthcare providers, if you support firearm safety and agree with common sense gun violence prevention strategies to make our communities safer please retweet this with #DoctorsForGunSafety - this isn’t about the second amendment, just public health