Retro-flex view of a rebuilt valve post-TIF

In a galaxy far far away there was a place where robots ruled the O/R Suite, cardiologists could check your pacemaker or defibrillator from your home, and you could have a major surgical procedure with no incisions. That far away galaxy is Louisiana in 2011. The da Vinci Robot from Intuitive Surgical has proven to be the most efficacious way to eradicate prostate cancer.

St. Jude Medical offers a full line of wireless pacemaker and defibrillators that can be checked via the Internet. And lastly, EndoGastric Solutions has revolutionized the treatment for GERD via their transoral incisionless fundoplication (TIF).

Transoral incisionless fundoplication is an innovative and effective surgical procedure for the treatment of GERD. Developed by EndoGastric Solutions, TIF is performed from within the patient’s stomach without incisions. This innovative procedure delivers patient outcomes similar to those provided by conventional antireflux surgical procedures, but is less invasive, has fewer adverse effects, and offers more future procedural options. TIF is able to repair the antireflux barrier, including reduction of hiatal hernia (≤ 2cm), restoration of the angle of HIS, and creation of a 3-5cm long antireflux valve with ≈ 280° circumference similar to Nissen, Toupet, Hill, and Belsey fundoplication procedures.

In a TIF procedure, the EsophyX device is placed over the endoscope. Once the patient has been placed under general anesthesia, the assembly is inserted into the patient’s mouth and the distal end of the endoscope is advanced into the patient’s stomach.

Tissue at the GE junction is pulled and wrapped into a fold, or placation. The fold is then anchored using SerosaFuse fasteners, equivalent to 3.0 sutures, which are delivered across the tissue to complete the fundoplication. The surgeon creates multiple plications, reconstructing the antireflux barrier and creating a substantial, tight, and robust gastroesophageal valve.

Hundreds of TIF cases have been done in the state of Louisiana since 2007 when the FDA cleared the procedure. TIF is endorsed by both ASGS (American Society of General Surgeons) and SAGES (Society of American Gastrointestinal and Endoscopic Surgeons).

The TIF Procedure is now offered at the following hospitals in Louisiana: Byrd Regional in Leesville, Jennings American Legion in Jennings, Lakeview Regional Hospital in Mandeville, Omega Hospital in New Orleans, Ochsner Main Campus in New Orleans, Ochsner Baton Rouge,
Ochsner Slidell, Our Lady of the Lake in Baton Rouge, St. Tammany Hospital in Covington, Thibodaux Regional, West Jefferson Medical Center in Marrero, and Women's & Children's in Lake Charles.

Douglas Tate, MBA, covers the states of Louisiana and Mississippi for EndoGastric Solutions. He has worked in sales and management for several medical device companies including: Guidant, Boston Scientific, Barrx Medical, and St. Jude Medical. He earned his BA and MBA from Louisiana State University in Baton Rouge. Any comments or suggestions can be emailed to him at dougctate@yahoo.com

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