The procedure, called Natural Orifice Translumenal Endoscopic Surgery (NOTES), involves passing surgical instruments through a natural orifice, such as the mouth or vagina, to remove a diseased organ such as an appendix or gallbladder. Only one incision is made through the belly button for the purpose of inserting a two millimeter camera into the abdominal cavity so the surgeons can safely access the surgical site.

Santiago Horgan, M.D., director of the UC San Diego Center for the Future of Surgery, is a world leader in minimally invasive surgeries, having performed 14 of these scarless NOTES procedures in the U.S. and Argentina. Horgan cites the critical role of biotechnology companies in bringing NOTES devices into the operating room for clinical trials.

“The path to innovation is dynamic, requiring quick response from the companies developing the tools,” said Horgan, president of the Minimally Invasive Robotics Association. “Partnership with industry keeps us rolling from one success to another. The evolution of surgery to incisionless techniques is on the horizon.”

By avoiding major incisions through the abdomen, patients may experience a quicker recovery with less pain while reducing the risk of post operative hernias. This procedure received approval for a limited number of patients by UC San Diego’s Institutional Review Board (IRB) which oversees clinical research.

“The UC San Diego Center for the Future of Surgery is investigating and refining techniques that are rapidly transforming the world of surgery,” said Mark A. Talamini, M.D., professor and chair of the Department of Surgery at UC San Diego Medical Center. “Imagine a day when surgery requires no incisions or just one tiny incision that is only millimeters in length. Scarless, painless techniques are what the UCSD Center for the Future of Surgery is setting the stage for right this minute. Patients deserve it.”

Schlamadinger, a third-year graduate student at UC San Diego working toward her Ph.D. in chemistry, reported her pain as a ‘1′ or a ‘0.5′ on a scale of 1 to 10, with 1 being the lowest. The opportunity to participate in the clinical trial was attractive to the scientist in her.

“The surgery appealed to me because the work and study I do every day relates to science research and discovery,” said Schlamadinger. “I understand the need for these trials to provide patients new information and new procedures.”

This is the fourth NOTES surgery that UC San Diego Medical Center has performed. The first surgery took place in September 2007 and the most recent on March 26, 2008.

Talamini will assume the position of President of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in Philadelphia the second week of April 2008. SAGES represents a worldwide community of surgeons who are bringing minimal access surgery, endoscopy and emerging techniques to patients in every country.

Horgan and Talamini used FDA-cleared RealHand High Dexterity instruments, developed by Novare Surgical. These laparoscopic instruments give the surgeon greater dexterity and control to move around organs and blood vessels. RealHand allows the instrument tip to track the surgeon’s hand movements and have been customized for transvaginal NOTES procedures. The surgery was guided by imagery enabled by a flexible, high-definition digital endoscope made by Olympus America.

In addition to Horgan and Talamini, the surgical team included: Bryan Sandler M.D., John Cullen M.D., Karl Limmer M.D., Emily Whitcomb, M.D., Benjamin Beal, M.D., Kathleen Naughton, R.N., and Jocelyn Floresca, R.N.

Credit: ScienceDaily

“We’ve noticed, using the GDx Nerve Fiber Analyzer, that there is a dropout of between 5-15% of the total nerve fiber layer following LASIK in patients who have had the suction on the eye for 30 seconds or more,” says Edward Yavitz, M.D., of the University of Illinois College of Medicine. “I only ran a group of 20 patients. But we had 20 out of 20 whose one eye showed nerve fiber thinning at one month. The opposite eye, which was treated by Alphagan, showed no loss.”

To create a uniform flap in LASIK, surgeons apply a suction ring that raises IOP to about 80-85mm Hg. The suction time—which varies from about 15-45 seconds depending on surgical skill and the type of microkeratome—may be a determinant of potential NFL thinning. Dr. Yavitz has found no nerve fiber loss (without Alphagan) in patients for whom the suction time was 20 seconds or less. In a separate study of 60 patients who received no Alphagan and had LASIK with suction times less than 30 seconds, New York surgeon Sanjeev Nath, M.D., likewise measured no significant nerve fiber loss on GDx.

Perhaps the tool matters as well. A microkeratome housing an integrated suction ring may allow for a quicker pass than a less-wieldy two-piece unit. Dr. Yavitz and the other investigators in the multi-center study plan to use various microkeratomes to gauge the effect of different suction times.

Skeptics initially questioned whether Dr. Yavitz’s findings might simply be artifacts reflecting postoperative changes in the cornea, a medium of the polarization measured by the GDx. (The system features a corneal compensator.) Dr. Yavitz refutes the skepticism by noting the absence of nerve damage in the Alphagan-treated eyes. The larger study aims to reproduce his findings using the same protocol as the pilot series: Alphagan tid in one eye and placebo in the other for three days pre-op and one week post-op, with GDx measurements preoperatively and one month after surgery. Dr. Yavitz hopes to complete the study within about a year.

In the meantime, should you warn patients about a possible risk of nerve fiber layer loss in LASIK? Dr. Yavitz thinks we should wait and see. After all, his was merely a small series of 20 patients. And remember, the GDx changes appeared only in cases where the suction time was 30 seconds or more. Besides, says Dr. Yavitz, the 5-15% NFL dropout measured in his patients may be clinically insignificant. The GDx measurements showed that, despite the loss, their NFL thicknesses remained within normal limits. “Since this is a patient population of high myopia, which is more prone to developing glaucoma later in life, we don’t like to see any nerve fiber layer loss at this early age,” Dr. Yavitz says.

Studies suggest that patients can sacrifice 30-50% of their nerve fiber layer before the onset of visual field loss. Even with that leeway, TLC’s J. James Thimons, O.D., considers the extent of NFL loss in the Illinois study cause for concern: “It means you’ve eaten up a third of the available nerve fiber layer before they show a field loss, according to some of the studies. That’s a huge change in the normal anatomy and physiology of the eye.”

Break it: Focus on her thighs and lower belly. Make a mental circle 2 inches around the outside of her vagina, and don’t cross the line while you kiss, lick, and caress, says Gloria Brame, Ph.D., author of Different Loving. You’ll ignite her nerve endings and bring her close to her red zone. It makes sex about discovery, not some destination. “Goal-oriented sex isn’t sexy,” Brame says.

Same Time, Same Place

Break it: Relive the past. Take her to the garage and reclaim the space you long ago ceded: Seduce her in the backseat of the car. It feels a little public, it’s steeped in testosterone, and there’s a throwback, high-school quality to it. Make it a quickie, which has its place in the sexual diet; having lots of sex begets more sex, because you stay connected, says Laura Berman, Ph.D., director of the Berman Center in Chicago.

Predictable Foreplay

Break it: Work out together. Think of it as fat-burning foreplay. It will raise her dopamine levels, easing her anxieties. “She’ll feel the sex is about her and not some random need she has to accommodate,” says Pepper Schwartz, Ph.D., a professor of sociology at Washington University. Bonus: Your post-run sweat has androstadienone, a testosterone derivative that spikes her arousal when she smells it.

Lopsided First Moves

Break it: Tie her hands. It’s now up to her to figure out how to remove your shirt, tie, cuff links, and pants. You’ll share a few laughs and marvel at her ingenuity. Whether you tie her up or she binds you, the game will break your predictable, first-move habits. The bonus: “It acts as an automatic foreplay extender,” says Berman.

TV, Then Sex

Break it: Read to her. It doesn’t have to be erotica. It’s an intimate activity that makes her focus on your voice. The deeper, the better. Low voices are a sign of high testosterone, which ups her attraction to you, according to a Scottish study. Read lying in bed with your head up, to dip an octave; it forces you to push air with your diaphragm instead of your lungs.

Habitual Hand Holding

Break it: Caress her neck. Sure, holding hands can work as an aphrodisiac: It shows her you’re devoted and proud to tell the world. But after a while, its poignancy wanes. A stepped-up PDA will deepen her connection to you, so she’ll be more willing to really give herself to you in the bedroom, says Schwartz.

Credit : menshealth.com

The statistic of donated and implanted organs in Thailand on 31st of July 2007, there are 2,251 patients who have waited for new organs and within these numbers, there are the 1,947 patients having last state of renal failure who need the kidney implanted, 246 for liver, 14 for heart, 26 for both heart and lung, 7 for lung, 6 for liver and 5 for kidney and pancreas.

While every year there are less than 200 patients who received new organ implants in 2007. From 1st Jabuary-31st July, there are 127 patients who received new organ implanted, 103 for kidney, 18 for liver, 4 for heart, 1 for heart and lung and 1 for kidney and pancreas. Some of the patients have died while waiting for body implant. In 2006, there 59 patients who died while waiting for organ donate which is 2.75 from all the patients who wait for the organs.

No mat how far the new technology is, if we have no donated organs, the patients cold never be healthy like they used to. Some of the patients have decided to get body implant by asking their relatives which the donation has done while the owner is alive. This is one of the solutions, although the giver and receiver must be related by blood or marriage spouse only.

Sometimes we might have seen the news about merchandising organs from the countries, especially in Asia which brought from the people in the poor country. Organ merchandising is seriously illegal and immoral. In medical profession, there are researches towards body implant in order to stop merchandising organ problem to become more serious.

Thai Red Cross and other medical institutions have realized the problem of lacking donated organs so that the organ donate center has found in 1994,honoured as a director by Pol.Gen.Pao Sarasin in order to become the center of organ donation. The main policy of the center is to supply the organs equally and morally without merchandising and provide the best use of the donated organs. However, during the past 13 years, the center has not received enough organs for the patients which their numbers are increased every year.

On the occasion of 60th Anniversary Celebrations of His Majesty’s Accession in to The Throne in 2006 and his Majesty 80th Anniversary in 2007, the Organ Donate Center by Thai Red Cross is campaigning for organ donation which supported by Ministry of Public Health, Nation Health Security Office and Thai Health Foundation.

The project of “Donating organ on the occasion of 60th Anniversary Celebrations of His Majesty’s Accession in to The Throne” will be held from 1st June-31st December 2007 in which to help the patients waited for the donated organs to receive the organ implanted. 500 patients are expected to receive organs and the campaign on donating organ is as well for the charitable purpose toward his Majesty the King. This campaign attempts to broaden the networks and helps while changing the negative attitudes toward organ donation and associate with other organizations to receive donated organs and provide more channels to reach the donors.

Thai people are the major part in which to activate these projects to become successful and help other Thai for their better living.

Certainty is as well uncertainty. You never know that one day you might be the “receiver” or the “giver”.