Posing an Option
Posing an Option | Dr. Tom Lavin, incisionless bariatric surgery, POSE (Primary Obesity Surgery, Endolumenal) The Surgical Specialists of Louisiana, advanced laparoscopic weight loss surgery Covington, Lafayette, New Orleans, Slidell, USGI EndoSurgical Operating System, EOS, Dr. Michael Thomas, ROSE (Revisional Obesity Surgery, Endoluminal).

Dr. Tom Lavin

New Orleans Surgeons Perform Groundbreaking Incisionless Weight Loss Surgery

NEW ORLEANS—Six weeks before the holiday season commenced, Tom Lavin, MD, performed a unique procedure—incisionless bariatric  surgery known as POSE (Primary Obesity Surgery, Endolumenal)—on his 39-year-old sister to boost her weight loss efforts.

At 5 feet 7 inches, 188 pounds, with a 32-33 BMI, his sister, Megan Duplain, was an ideal candidate for the procedure. A week before Thanksgiving, she had already dropped 14 of the 40 pounds needed to reach her target weight.

“She’d had a lifetime of battling weight,” said Lavin. “She’d been trying to get me to do a laparoscopic bariatric procedure but didn’t qualify because she fell in the range of many people who need to lose 30 to 70 pounds, and the laparoscopic bariatric procedure is for 100-pound overweight people. I told her about POSE, and she came in from Phoenix, had the procedure on Tuesday at noon, went back to my house two or three hours later to rest, and flew back to Phoenix the next day at noon. It’s had a huge impact on decreasing her hunger drive and removing her cravings. She now fills up on a very small amount. When you start losing weight, you get that motivation to continue and exercise and feel better.”

Lavin, founder of The Surgical Specialists of Louisiana, an advanced laparoscopic weight loss surgery practice with offices in Covington, Lafayette, New Orleans, and Slidell, is among a handful of surgeons worldwide trained to perform the procedure that requires an endoscopic surgery tool, the EndoSurgical Operating System™ (EOS) and a flexible endoscope to visualize the stomach. Here’s how it works: Lavin inserts both the scope and the EOS tool through the patient’s mouth and then uses the tool to grasp the stomach lining before deploying polyester suture anchors to hold the tissue in place while creating multiple tissue folds on the stomach wall, thereby reducing the stomach’s size and capacity. By eliminating surgical incisions, patients benefit from reduced risk of infection, less post-operative pain, faster recovery time, and the riddance of scars following the procedure. No supplements are required post-surgery; there’s no special diet, though healthy eating is highly encouraged.

“Our group has done about 7,000 cases (of laparoscopic bariatric procedures), and going to endoscopic is such a big deal because you have no incisions, they’re done outpatient, and there’s essentially no down time,” said Lavin.

Michael Thomas, MD, another bariatric surgeon in the group, made medical history by performing the first POSE procedure in the Gulf Coast region, and only the third in the world, on a 51-year-old female with high blood pressure and early signs of type 2 diabetes who had been battling weight since adolescence.

“About three or four years ago, USGI contacted me and asked if I thought incisionless endoscopic weight loss procedures were a possibility,” said Lavin, who is among few primary investigators for USGI’s EOS, along with Thomas. “I said I thought so, but the technology wasn’t there yet. USGI already had the technology to do the POSE procedure and we were invited to be part of an international registry that performed 27 procedures over approximately six months. We performed one-third of the procedures that were done in several multinational sites—(ours represented) more than any site in the registry—and had such good results that we continued to do the procedure in our surgical practice after the registry was over. We really haven’t marketed the procedure yet, but we’re at a point that our patients are so happy and doing so well … it’s such a safe procedure that we’re now letting doctors as well as the general public know of its availability. We’re the only ones in America doing (the POSE procedure) right now.”

Lavin was the first surgeon in Louisiana to use a similar incisionless technique for patients who previously had gastric bypass and have regained their weight.  The ROSE (Revisional Obesity Surgery, Endoluminal) procedure restores gastric bypass patients’ stomach pouch and stoma to closely match original post-surgery sizes.

Unremarkably, four of five Surgical Specialists patients are women. Perhaps surprisingly, they’re not all middle-aged. The age range, Lavin said, spans from late teens to seniors.

“As you get people to lose weight, you can resolve or at least dramatically improve several serious diseases and conditions commonly associated with obesity, including type 2 diabetes, hypertension, sleep apnea, joint dysfunction, and cardiovascular disease,” said Lavin. “In addition to health benefits, it improves the patient’s quality of life. By not fighting that weight battle all day every day, people are much happier, particularly ladies. When they’re overweight, ladies typically don’t engage in society in normal fashion. Once they lose their excess weight, they do.”

Because insurance doesn’t cover the procedures, it’s a cash business. A typical POSE or ROSE procedure costs roughly $10,000 to cover the hospital, anesthesia, surgery and equipment expenses. To accommodate the new procedures in their already busy practice of six bariatric surgeons, three POSE procedures are performed every Tuesday. “We’ll probably go to Monday also,” said Lavin. “Those procedures only take an hour; we do other procedures during that day.”

With two of three Americans now classified as overweight or obese, according to the latest data from the Centers for Disease Control and Prevention (CDC), Lavin is gearing up for a busy 2011. Even though he isn’t training American physicians on the technique per USGI’s request, European and Israeli bariatric surgeons have traveled to South Louisiana to receive training from Lavin, who has been contacted by The London Times and other international publications about the procedure.

“It’s pretty unbelievable the level of attention this is getting,” said Lavin. “It’s a safe, effective procedure for people who wouldn’t qualify for bariatric surgery from a weight standpoint.”