This year’s Distinguished Lecture of the International Society of Surgery (ISS) will offer surgeons a look at an approach that has transformed flexible endoscopy from a largely diagnostic tool into a platform for therapeutic intervention.
Haruhiro Inoue, MD, PhD, a professor at Showa University School of Medicine and director of the Digestive Disease Centre at Showa University Koto-Toyosu Hospital in Tokyo, Japan, internationally recognized for pioneering techniques that allow surgeons to treat gastrointestinal conditions through flexible endoscopy.
“Most of the surgeons are mainly focusing on surgical endoscopy, that is, laparoscopic surgery or da Vinci surgery. For surgeons, it's a major topic. But I am also focusing on the intraluminal approach,” he explained.
In his lecture, today from 2:30 to 3:30 pm in Room 202B, Dr. Inoue will highlight the innovations that have helped advance this approach. “Advanced Flexible Endoscopic Surgery in GI Tract: From ESD, POEM, Third Space Endoscopy, and EFTR” (NL07) will include insights into endoscopic submucosal dissection (ESD), peroral endoscopic myotomy (POEM), and endoscopic full-thickness resection (EFTR).
Third-space endoscopy involves using a flexible endoscope to enter the “third space,” or submucosal space in the digestive tract wall, providing access to the muscle layer for therapeutic interventions. These approaches can offer minimally invasive alternatives to conventional surgery for appropriately selected patients.
Among Dr. Inoue’s best-known innovations is POEM. Although surgical myotomy was introduced more than a century ago, Dr. Inoue and colleagues performed the first POEM in a human in 2008. The initial goal, Dr. Inoue has said, was to treat achalasia, a disorder of the esophagus, without creating scar tissue.
Dr. Inoue and colleagues published their experience with the first 500 patients who underwent POEM in the Journal of the American College of Surgeons in 2015. His hospital has since performed more than 4,200 POEM procedures, and the technique has been adopted around the world.
He also has developed modified versions of POEM to treat reflux disease and tumors. “Submucosal tumors can be now removed by the flexible endoscopy alone,” he said. “Of course, there is a size limitation. If the tumor is too large, laparoscopic surgery is better. So, small lesions, less than 3 centimeters, we can remove endoscopically.”
His lecture also will discuss EFTR, which uses endoscopic techniques to remove deeper diseased tissue from the gastrointestinal tract.
“One of the exciting ones is a full thickness resection,” he said. “The whole GI wall is removed endoscopically, not surgically, and then we can close the defect using endoscopic clips. That is our new procedure.”
Dr. Inoue said the lecture will have relevance for surgeons across specialties who are interested in incorporating flexible endoscopic techniques into their practice.
He emphasized that attendees could expect to hear about a fundamentally different way of operating.
“The platform to do the procedure is totally different from a laparoscopic surgery. Laparoscopy surgery and the da Vinci surgery are very similar technically, but in flexible endoscopic surgery, the platform, the device, and the technique are totally different,” he said.
This Named Lecture series is endowed by the US chapter of the International Society of Surgery to recognize the society’s contributions and honor distinguished international surgeons.
