By Alex Strauss
The Surgical Institute of South Dakota’s Bradley Thaemert, MD, FACS, recently became the first surgeon in the region to use a new device designed to help surgeons get around what has been a major hurdle for endoscopic surgery.
“One of the things that had held us back, as far as endoscopy goes, is that we have not had the ability to suture,” says Dr. Thaemert, a general surgeon with expertise in Single Incision Laparoscopic Surgery (SILS) and other minimally invasive techniques. “Until this device, there has really not been a good way to do surgery with the endoscope. This is what the Apollo OverStitch has brought us.”
The OverStitch Endoscopic Suturing System from Apollo Endosurgery, purchased last summer by Avera McKennan, gives Dr. Thaemert (the only local surgeon currently trained in the use of the system) the opportunity to use the endoscope for a much wider range of applications. The system, which mounts on existing endoscope platforms, makes it possible to place full-thickness sutures through the endoscope, controlling the depth with a special curved-needled design.
“The technique is really something that we surgeons have been anticipating for years,” says Dr.
Thaemert, for whom the system represents the latest stage in the evolution of minimally invasive
surgery. “We started out doing open procedures, moved to less invasive laparoscopic surgery to scarless single incision surgery. Now, with this system, we are looking at surgery with no scars at all.”
The OverStitch system was designed for maximum surgical flexibility, allowing surgeons to deploy both running and interrupted stitches. It can be used with one hand and requires only one operator. Suture material is available in both absorbable and non-absorbable varieties (2-0 Polypropylene and 2-0 Polydioxanone). The addition of a corkscrew-shaped helix attachment easily anchors the device into tissue, enabling precise suture placement and depth control with minimal trauma to the underlying tissue.
“You are using a dual lumen, so you have two channels that you are working through,” explains Dr. Thaemert. “It’s like having an extra port.” At the close of the procedure, the cinch design means Dr. Thaemert’s stitches will be held in place without the need for him to tie a complex surgical knot. To ensure maximum patient safety, the device is packaged for individual use.
“My goal with this system was to start out with the basics, doing non-emergency procedures to fix
various kinds of holes,” explains Dr. Thaemert. An example is the gastrogastric fistula, which can be a complication of gastric bypass surgery. “In the old days, the only option was to do an open surgery to take down those fistulas. With the OverStitch, we can offer an alternative, minimally invasive surgery through the mouth. So that is where we started.”
As with any new tool, new uses for the OverStitch have surfaced as Dr. Thaemert has become more familiar it. (“Now that we have the technology, we have the hammer and we are looking for the nails,” he says.) Recently, he has begun using the system to close down openings in the stomach that have become too large after gastric bypass surgery. During the outpatient procedure, Dr. Thaemert uses the OverStitch to help restore the original level of restriction so patients continue to get the maximum benefit from their gastric bypass.
For patients who have had sleeve gastrectomy for weight loss, Dr. Thaemert has used the device to repair small leaks along the staple line. Bleeding following esophageal cancer resection or removal of large polyps in the colon can both be repaired with the OverStitch. In non-resectable esophageal cancer cases where a stent has been placed, the OverStitch has allowed Dr. Thaemert to suture the stent in place, preventing shifting.
Dr. Thaemert is using the Apollo OverStitch system a couple times a month right now, but expects that uses for the tool with continue to expand. Eventually, he anticipates that, rather than merely fixing complications of weight loss surgeries, the device may be used to offer a completely new kind of weight loss procedure. One that can even be performed on an outpatient basis.
“The OverStitch device will make it possible to offer a stand-alone restrictive procedure instead of sleeve gastrectomy or lap band surgery. Essentially, you would just be stitching the stomach together from the inside,” explains Dr. Thaemert. Unlike more invasive weight loss surgeries, a weight loss procedure with the OverStitch system can be performed with little or no pain, no lost work time, and no scarring.
For the time being, Dr. Thaemert says the OverStitch remains an increasingly important surgical
‘problem solver’. “This does not replace resectional surgery, but it can help us get out of trouble and protect patients from needing much more invasive procedures to fix problems. That is what is really exciting about this device… its ability to get people out of problems. This is here to stay, there’s no doubt.”
About Dr. Thaemert:
Bradley C. Thaemert, MD, FACS is a board certified general surgeon General Surgery. He is a member of the American Society of Bariatric Surgeons and the Society of Laparoscopic Surgeons. Dr. Thaemert serves as the South Dakota Chairman of the Committee on Trauma for the American College of Surgeons. He has also served as the past Chairman of the Department of Surgery as well as a member of the Board of Trustees at Avera McKennan Hospital.