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Nearly Scarless Surgeries

Natural orifice transluminal endoscopic surgery, also known by the friendlier name NOTES, is a technique that combines laparoscopic and endoscopic techniques to access the body through natural openings, such as the mouth or anus. These minimally invasive approaches take the place of larger incisions in traditional surgeries that could leave unpleasant scars, pain and infection.

Michael Awad, MD, a minimally invasive surgeon trained in robotic surgery and NOTES, joined the Washington University faculty in fall 2009. Awad, along with Brent Matthews, MD, chief of minimally invasive surgery, and other faculty members, are using and researching surgical techniques for procedures on the gallbladder, liver, bile ducts, small intestine and other organs.

NOTES is a part of the Natural Orifice Surgery Program at Washington University and Barnes-Jewish Hospital. Clinical trials will begin in the fall to evaluate laparoscopic cholecystectomy, a procedure in which surgeons remove the gallbladder through the mouth.

"The holy grail of surgery for us would be to operate under just local sedation as an outpatient procedure where the patient could walk out of the hospital the same day with minimal pain and resume normal activity quickly," Awad says.

Only 500 NOTES procedures have been performed worldwide.

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