Surgeons at UCSD made history last month by performing the first NOTES appendectomy in the United States. We spoke with lead surgeon Dr. Santiago Horgan about the details of the procedure and the future of the NOTES technique.

According to Dr. Horgan, the procedure lasted approximately three hours, with minimal bleeding and no complications. The operating team had practiced and refined their technique on animal models for over two years before attempting it on a human. The patient himself, a forty-year-old former marine, reported only 2/10 pain during recovery and told WebMD that he was able to do sit-ups within just four days. Proper healing of his gastric incision has been inferred from the absence of fever or abdominal pain.

Dr. Horgan noted that the team has also performed a dozen NOTES cholecystectomies, and that the positive results from both procedures confirm that NOTES is a viable technique with important advantages. “We’ve proven this approach works,” he said. “We’ve seen the impact on patient care and on outcome: less pain, quicker recovery, improved cosmetics.”

Dr. Horgan warns, however, that NOTES is not yet ready for wide adoption, and that years of technical development are still needed. “The problem is that eighty percent of the endoscope still goes to the light and the camera, while only twenty percent goes to the working channels,” he said. “It needs to be the other way around. Although companies like USGI have been working on better platforms, we still don’t have an ideal NOTES scope.” 

When asked which other procedures might soon be candidates for NOTES, Dr. Horgan said, “I expect we’ll be using NOTES for gastroesophageal reflux repair and obesity surgery in the near future.”