Dr. Andrew Luhrs is a bariatric surgeon specializing in minimally invasive techniques. He, along with two other Rhode Island surgeons, recently performed two separate gastrointestinal procedures with the help of innovative technology. Surgeons were able to access internal organs with the use of a camera inserted through patients’ mouths, eliminating the need for some outer incisions.
Luhrs, who is on staff at Brown Surgical Associates, is also an assistant professor of surgery at the Warren Alpert Medical School of Brown University.
PBN: Recently, you and two other surgeons were the first to perform a per-oral pyloromyotomy and a per-oral endoscopic myotomy in Rhode Island. What are those procedures?
LUHRS: These procedures are used for the treatment of gastrointestinal disorders of motility. The per-oral endoscopic myotomy (POEM) procedure is used in the treatment of achalasia. In achalasia, there is an abnormality in the way the muscles of the esophagus function. The esophagus is unable to contract normally and the lower esophageal sphincter, which is the muscle between the esophagus and stomach, is unable to relax. Due to these abnormalities, patients with achalasia have food that gets stuck in the last portion of the esophagus.
A POEM procedure uses an incision-free technique to cut the lower esophageal sphincter muscle allowing the esophagus to drain more normally, alleviating [the] patient’s symptoms. This is done with the use of an endoscope through the mouth.
The per-oral pyloromyotomy (POP) is a very similar procedure, which is used in the treatment of gastroparesis. In gastroparesis, the stomach is unable to contract normally. Food, therefore, sits in the stomach for prolonged periods of time, which causes a host of symptoms. The POP procedure uses the endoscope to go in through the mouth and cut the pylorus muscle – the muscle that sits between the stomach and small intestine. This leads to improved drainage of the stomach and improves symptoms from gastroparesis.
PBN: Was the patient’s recovery time noticeably different from recovery time associated with the traditional myotomy and the Heller myotomy?
LUHRS: Due to the fact that there are no incisions with these approaches, patients have a noticeably shorter recovery period. While there can be some pain related to cutting the muscle, the pain and discomfort from surgical incisions are avoided.
PBN: The conditions that the POP and POEM treat are relatively rare. How much demand is there for the procedures, and can they be modified to treat other things?
LUHRS: Gastroparesis and achalasia are relatively uncommon. However, they can lead to significant problems for those patients who are affected. We see a significant number of patients annually presenting with these conditions and these procedures offer a minimally invasive approach to managing these conditions. There are currently no modifications of these procedures to be used in other conditions.
PBN: What does the availability of incision-free procedures such as the ones that you are performing mean for patients?
LUHRS: While complications for procedures like Heller myotomy and pyloromyotomy are relatively low, the POEM and POP are incision-free procedures performed through the mouth with an endoscope. This approach reduces post-surgical pain and removes the risk of superficial surgical site infections. Patients often can go home sooner than more traditional procedures and often recover quicker.
PBN: Are surgeries like these that make use of cameras and monitors much more of a team effort than similar traditional procedures?
LUHRS: I am fond of saying that surgery is a team sport. Whether performing a laparoscopic Heller myotomy or POEM, the surgeon relies on the assistance and support of nursing staff, surgical scrub techs and first assistants.
Additionally, due to the fact that patients with achalasia and gastroparesis are typically followed very closely by their gastroenterologists, it is extremely important for surgeons performing these procedures to have a close working relationship with the gastroenterologists caring for these patients. Thankfully, I am blessed to work with truly exceptional people in all of these fields.
Elizabeth Graham is a PBN contributing writer.
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