Mini Scarless Surgery and NOTES

Natural Orifice Transluminal Endoscopic Surgery

NOTES (Natural Orifice Transluminal Endoscopic Surgery) became popular nearly 18 years back. The idea was to perform surgery, which will leave no scar on the abdomen, hence the name NOSCAR in the US. An endoscope is introduced through the mouth; the stomach is pierced, the gallbladder is dissected free, it is removed through the mouth with the scope, and the hole is closed.

Conceptually a great idea with much less post-operative pain and no scars on the abdomen. It became very popular in Latino countries due to a greater focus of females on their body image and cosmesis. 

However, the issues with these surgeries were many; hence it is not popular in many countries. Operative time was far too long; 4 to 5 hours rather than 15-20 minutes for a gallbladder operation. This made the operation too expensive for insurance companies and patients. 

The complications from stomach wall closure and leak rate were high as well. These issues remain to date, and result in this operation is performed in very few places. 

Professor Amir’s Take on NOTES

Professor Nisar’s keenness to learn new techniques led him to attend courses and meetings in NOTES in 2006 onward. His EndoAlpha hybrid theatre in Maidstone Hospital, Kent, United Kingdom, was built and equipped to perform NOTES and many other advanced hybrid operations. However, after careful evaluation of the technique and despite his skills and expertise in both laparoscopic surgery and Endoscopy, including ERCP (Endoscopic Retrograde Cholangio Pancreatography), he chose not to perform this surgery due to the higher risk than the established operation. 

This led to Professor Nisar’s quest to further improve on the traditional laparoscopic and robotic-assisted laparoscopic surgery. 

Innovative and Safe New Approaches

Needlescopic surgery for Laparoscopic Cholecystectomy, Laparoscopic Totally ExtraPeritoneal (TEP) Hernia Surgery, Laparoscopic Nissen’s Fundoplication and Laparoscopic Appendicectomy, just to name a few, were improved hence the names Needlescopic Cholecystectomy, Needlescopic Totally ExtraPeritoneal (TEP) Hernia Surgery, Needlescopic Nissen’s Fundoplication and Needlescopic Appendicectomy. 

The results were great, and patients were happy, but there was still room for further improvement.  

“MSL” Mini ScarLess Laparoscopic Surgery

Slight changes, modifications, better equipment, and team training has led to new innovation. “MSL” Mini ScarLess laparoscopic surgery is done through the abdominal wall, which undoubtedly will leave a scar after healing. Still, these are so subtle that the patient, operating surgeons, or experienced laparoscopic surgeons will struggle to find these just a few weeks after the surgery.  

Benefits of “MSL” Mini ScarLess Laparoscopic Surgery

Apart from the cosmetic superiority of this procedure over open surgery/laparoscopic/robotic-assisted laparoscopic surgery and needlescopic surgery SILS/ / NOTES; MSL surgery offers even less post-operative pain, quicker recovery and no restriction on exercise post-operatively in hernia, gallbladder and appendix surgery. This translates into an early return to driving, early return to work, and an early return to exercise and full fitness. Professor Nisar and his team are rightly proud of being the first in the world to perform these operations.