Santiago Horgan: Surgeon as Game-Changer

Cheryl Clark, December 2, 2010

"Whatever we are doing is making them say, 'Wow!' It shows people want something different, something better."

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is Santiago Horgan's story.

When nighttime talk show hosts make jokes about surgeon Santiago Horgan and his novel approach in the operating room, he says, "Bring it on."

"If people are making jokes, like on The Colbert Report or Jay Leno, it's because they are paying attention, and whatever we are doing is making them say, 'Wow!' It shows people want something different, something better."

In the past four years, Horgan, with his surgical team at the University of California San Diego Health System, has performed 80 surgeries that use the body's natural openings—the vagina or the mouth—to remove organs and tissue; that's eight times more procedures done in this fashion than anywhere else in the country.

In so doing, the surgical team is well on the way to proving it can reduce operating time and the risk of infection, lower the need for anesthesia, minimize pain and lessen or eliminate scarring, hasten patients' recovery and reduce complications better than with traditional laparoscopic approaches, he says.

Instead of traditional incisions in inches, the procedures use much smaller cuts to insert cameras and specialized versions of surgical tools. Horgan calls the technique a "game changer."

The strategy is called NOTES, for natural orifice translumenal endoscopic surgery. Although about 2,000 have been done around the world, only 120 have been done so far in the United States and most of those at UC San Diego.

So promising is the technique that Horgan's team's successes have launched a national clinical trial to test the approach in multiple centers nationally. Every one of Horgan's patients is being followed and each has recovered without complication.

At UCSD, Horgan, with members of his team, has repaired hernias through the vagina and removed gall bladders and appendixes through the vagina and the mouth.

He has repaired a condition called achalasia, a disorder marked by difficulty in swallowing, through the mouth.

Most recently, he and his team performed the first sleeve gastrectomy—the removal of 80% of an obese woman's stomach—through the mouth, an alternative to the more invasive laparoscopic bariatric surgery.

Next up, he says, are efforts to see if they can safely remove an appendix or a gall bladder through the colon and rectum.

It seems the possibilities are endless.

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