Less invasive, more inventive: Surgery hosts final session of “MedSurg Presents” program for 2018

On September 21, two visiting physicians from the Cleveland Clinic spoke to a nearly full training room of Cook employees from several different functions, including Product Management, Engineering, Clinical, Regulatory Affairs, Marketing, and Sales. Drs. John Rodriguez and Emre Gorgun visited Park 48 to share their experiences and future predictions on the advancement of surgical procedures.

Dr. Rodriguez is the director of surgical endoscopy at the Cleveland Clinic and an assistant professor of surgery at the Cleveland Clinic Lerner College of Medicine in Cleveland, Ohio. Dr. Gorgun is the Krause-Liberman Chair in laparoscopic colorectal surgery in the department of colorectal surgery at the Cleveland Clinic.

This event, titled “Less invasive. More inventive,” is part of program within MedSurg called “MedSurg Presents” that allows each of the six specialties in the division to educate one another on their specific customers, products, and procedures. This was the program’s final session for 2018.

“This is an opportunity to showcase the current and future forms of specialized care for patients suffering with some of the most prevalent diseases in the world: obesity, diabetes, and colon and rectal disease,” said Aaron Stephens, global product manager for the Surgery specialty.

Battling obesity

The first presentation, given by Dr. Rodriguez, was entitled “Future Surgical Treatments for Diabetes and Obesity.”

“Obesity has become the largest epidemic in the modern era,” he said. “Bariatric surgery has been established at the best and most effective treatment for obesity and weight-related medical conditions. However, there continues to be a discrepancy between the obesity epidemic and the outreach of bariatric interventions.”

Dr. Rodriguez attributes these discrepancies to access barriers, patient fear, insurance and socioeconomic hurdles, and misconceptions about bariatric surgery.

“According to GLOBALHealthPR, Justin Bieber was mentioned over six million times in one month,” Dr. Rodriguez said. “Unfortunately, the topic of childhood obesity was discussed only 15,000 times.”

Dr. Rodriguez said his rationale for new procedures to treat obesity include decreasing complications from established procedures, improving the metabolic effect in patients for post-procedures, finding less invasive alternatives to surgery, and widening the reach of patients that are able to be treated.

According to Dr. Rodriguez, the current “gold standard” for obesity procedures is the sleeve gastrectomy. In this procedure, the stomach is reduced in size by the removal of a portion along its greater curvature. The end result is stomach shaped like a sleeve or tube.

“The endoscopic sleeve gastroplasty is the most sought-after procedure right now,” Dr. Rodriguez said. “This procedure reduces the entire stomach along the greater curvature to form an endoscopically created sleeve. This is an entirely endoscopic procedure. As of right now, this procedure is the most effective and durable. All new inventions will have to be compared to the gold standard, which is the sleeve, currently.”

Newer treatments options for obesity are exploring the concept of space-occupying devices, including balloons, funnels, and endoscopic stents.

Another more recent development is the use of endoscopic magnets. The magnets are connected to create a compression opening or “anastomosis.” When the anastomosis is fully formed, the magnets are passed. A treatment path is created, bypassing a portion of the small intestine. Two standard endoscopes are then used to access the small bowel. The self-forming magnets are then deployed from the working channel of each endoscope.

“This is really exciting technology,” Dr. Rodriguez said. “The complications have been low in animal studies. There’s lots of potential applications and interest in using these endoscopically delivered magnets.”

The future of polyp removal

Dr. Gorgun’s presentation was entitled “A Leap Forward: EndoLuminal Surgery” and was focused on the removal of polyps, abnormal tissue growths, in the treatment of colorectal cancer.

“In my experience, up to 15% of colonic polyps require more advanced polypectomy techniques due to their size, location, or appearance,” he said.

One removal method he discussed was endoscopic submucosal dissection (ESD). In ESD, electrosurgical cutting devices are used to dissect the deeper layers of the submucosa, a thin layer of tissue.

“With ESD, you can get a full histologic evaluation,” Dr. Gorgun said. “Polyps also have a lower recurrence rate.”

Dr. Gorgun then spoke about newer technologies that use ESD for polyp removal, including Lumendi’s DiLumen^®and Boston Scientific’s ORISE^® Tissue Retractor System. The DiLumen is a dual balloon that is used with an endoscope to visualize, diagnose, and treat conditions within the large intestine. The ORISE Tissue Retractor System received 510(k) clearance from the Food and Drug Administration (FDA) in February of this year. [1] According to the FDA website, it is intended “to facilitate passage and aid in the advancement of endoscopes into the body, especially in cases of repeated intubation.” [2]

In his closing remarks, Dr. Gorgun highlighted the importance of developing of minimally invasive medical devices, one of the founding principles of Cook.

“These new platforms and refined innovative instruments will prove imperative in enabling ESD and organ preservation,” Dr. Gorgun said. “These new inventions, along with more training courses for surgeons, will absolutely change this practice.”

Drs. Rodriguez and Gorgun are paid consultants of Cook Medical.

 

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[1]. 510(k) Premarket notification. U.S. Food & Drug Administration. Last updated September 17, 2018. Accessed September 24, 2018. accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=K173400.

[2]. Product classification. U.S. Food & Drug Administration. Last updated September 24, 2018. Accessed September 24, 2018. accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=1760.