Continual Advancements Fuel 'The Laparoscopic Revolution'

From the 2014 Department of Surgery Annual Report

AFTER PASSING SURGICAL instruments through a patient’s mouth and making a small incision in the lining of the esophagus, a Washington University minimally invasive surgeon and endoscopist corrected a problem that prevented a 54-year-old woman from easily swallowing food and liquids. The procedure, performed in 2013, was one of the first of its kind in the region performed through a natural opening in the body rather than an external incision.

“The ‘holy grail’ we’ve been striving for is the ability of a patient to have surgery for which they come to the hospital, go to sleep, have the procedure and wake up with no pain,” says minimally invasive surgeon Michael Awad, MD, PhD, who performed the operation with interventional endoscopist Faris Murad, MD, at Barnes-Jewish Hospital. “With this procedure, we’re getting close.”

Michael Awad, MD, PhDThe procedure, used to correct the swallowing disorder known as achalasia, is called peroral endoscopic myotomy (POEM) and is the latest example of leadership by Washington University surgeons in a history that goes back to the early days of minimally invasive surgery.

Nathaniel Soper, MD, a laparoscopy pioneer, performed the first laparoscopic gallbladder removal in Missouri in 1990. He and L. Michael Brunt, MD, who performed the first laparoscopic adrenal gland removal in the state, were the early surgeons who performed an array of laparoscopic procedures and became the “GI” part of the Section of Hepatobiliary-Pancreatic and Gastrointestinal (HPB-GI) Surgery when it formed in the early 1990s.

“Today we still call it the laparoscopic revolution,” says Brunt, who stayed on, while Soper left for Northwestern University. “The goal wasn’t simply having a low complication rate. It was the benefits of less pain, faster recovery and return to full activity sooner.”

L. Michael BruntL. Michael Brunt, MDIn 1993, surgeons joined with gastroenterologists to form the Washington University Institute for Minimally Invasive Surgery, the first multidisciplinary group in the country to advance research, education and patient care in minimally invasive surgery. Minimally invasive surgeons formed their own section in 2007 and by then had moved from an early emphasis on foregut and solid organ surgery to also offer bariatric surgery and repair of complex abdominal wall hernias. Biomaterials researcher Corey Deeken, PhD, joined the section to study the science behind abdominal wall hernias and their interactions with surgically placed meshes and to develop novel meshes for repair.

“From here we are going to increasingly focus on measuring outcomes and do more procedures — such as POEM — endoscopically,” says Brunt, who has served as chief of the Section of Minimally Invasive Surgery since July 2014.