Transvisceral Surgery

Reports have emerged in the last few years of forays in-tothe new realm of transvisceral surgery. Investigators have endeavored to develop methods of endoscopically incising the stomach and passing a flexible endoscope into the peritoneal cavity where a variety of procedures have been attempted [5]. These have included gastrojejunostomy, fallopian tube ligation, appendectomy, and cholecystectomy. The organs removed are withdrawn through the stomach with the endoscope, and the gastric wall is sutured closed from within. Most of these procedures have been performed in animal models, but there are anecdotal reports in humans.

Clearly, the value and limits of such a concept will need to be defined. However, this new approach to in-tra-abdominal surgery is a new initiative in minimally invasive surgery. The incorporation of robotic manipulators to enhance complex maneuvers may also potentiate the value of these procedures.

While endoluminal endoscopic techniques have been deemed the realm of the gastroenterologist, they have continued to erode the domain of general surgeon with the development of effective and less invasive therapies for common disease processes. Surgeons will need to become involved in these methodologies or find themselves irrelevant in the future care of many common intra-abdominal maladies [6].

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